{"hospital_name":"Memorial Healthcare","last_updated_on":"2025-03-01","version":"2.2.0","hospital_location":["Memorial Healthcare","Memorial Healthcare Behavorial Health"],"hospital_address":["826 West King Street, Owosso, MI 48867","826 West King Street, Owosso, MI 48867"],"license_information":{"license_number":"1060000059","state":"MI"},"affirmation":{"affirmation":"To the best of its knowledge and belief, the 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 indicated.","confirm_affirmation":true},"financial_aid_policy":["20% off of facility standard gross charges."],"standard_charge_information":[{"description":"TNKase","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":35470.8,"setting":"both","billing_class":"facility"}]},{"description":"Platinol","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":114.36,"setting":"both","billing_class":"facility"}]},{"description":"Mesnex","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"25021020110","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"ROOM,PRIVATE-2N","code_information":[{"code":"1100110","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-3S","code_information":[{"code":"1100140","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":3248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE PT REQUEST","code_information":[{"code":"1100141","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":3439.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-PEDS","code_information":[{"code":"1100145","type":"CDM"},{"code":"113","type":"RC"}],"standard_charges":[{"gross_charge":3239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-4W","code_information":[{"code":"1100150","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":3239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-4S","code_information":[{"code":"1100170","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":3239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-LTC","code_information":[{"code":"1100180","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":854.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-SKILLED","code_information":[{"code":"1100200","type":"CDM"},{"code":"110","type":"RC"}],"standard_charges":[{"gross_charge":3487.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PRIVATE-OB/3N","code_information":[{"code":"1100480","type":"CDM"},{"code":"112","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIVATE-2N","code_information":[{"code":"1200090","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIV-BEH HEA","code_information":[{"code":"1200100","type":"CDM"},{"code":"124","type":"RC"}],"standard_charges":[{"gross_charge":2420.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"BED HOLD-BEH HEA","code_information":[{"code":"1200104","type":"CDM"},{"code":"124","type":"RC"}],"standard_charges":[{"gross_charge":2420.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIVATE-OB/3N","code_information":[{"code":"1200130","type":"CDM"},{"code":"122","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIVATE-3S","code_information":[{"code":"1200140","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIVATE-4W","code_information":[{"code":"1200150","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":3239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIVATE-4S","code_information":[{"code":"1200170","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":3239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIV LTC","code_information":[{"code":"1200180","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":854.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIV-SKILLED","code_information":[{"code":"1200200","type":"CDM"},{"code":"120","type":"RC"}],"standard_charges":[{"gross_charge":3487.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM, SEMI-PRIVATE-COVID","code_information":[{"code":"1200300","type":"CDM"},{"code":"120","type":"RC"}],"standard_charges":[{"gross_charge":3487.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,SEMI PRIV-PEDS","code_information":[{"code":"1200480","type":"CDM"},{"code":"123","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"SP DETERMINE REFRACT STATE-MMA","code_information":[{"code":"1300100","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"SP SURGICAL CONCIERGE SERVICES","code_information":[{"code":"1300140","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":312.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM-NURSERY","code_information":[{"code":"1700010","type":"CDM"},{"code":"170","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM-ICU","code_information":[{"code":"2000010","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":6646.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,ICU SPECIAL","code_information":[{"code":"2000015","type":"CDM"},{"code":"121","type":"RC"}],"standard_charges":[{"gross_charge":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM-ICU-4S","code_information":[{"code":"2000020","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":6629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM-COVID ICU","code_information":[{"code":"2000050","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":6629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ROOM,PCU","code_information":[{"code":"2000206","type":"CDM"},{"code":"206","type":"RC"}],"standard_charges":[{"gross_charge":5051.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Absorbase Ointment","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500003","type":"CDM"},{"code":"637","type":"RC"},{"code":"46287050704","type":"NDC"}],"standard_charges":[{"gross_charge":21.3,"setting":"both","billing_class":"facility"}]},{"description":"Orencia","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2500004","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"00003218713","type":"NDC"}],"standard_charges":[{"gross_charge":7303.5,"setting":"both","billing_class":"facility"}]},{"description":"ACAMPROSATE CALCIUM","drug_information":{"unit":"333","type":"ME"},"code_information":[{"code":"2500007","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687012125","type":"NDC"}],"standard_charges":[{"gross_charge":8.93,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol #3 300mg/30mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500010","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"setting":"both","billing_class":"facility"}]},{"description":"Norco 10/325","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500015","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406012562","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2500045","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Volsol OTIC 10mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500085","type":"CDM"},{"code":"637","type":"RC"},{"code":"51672300701","type":"NDC"}],"standard_charges":[{"gross_charge":548.82,"setting":"both","billing_class":"facility"}]},{"description":"Miochol-E 20 MG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500090","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":771.84,"setting":"both","billing_class":"facility"}]},{"description":"Mucomyst 20% 30mL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500102","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"gross_charge":156.06,"setting":"both","billing_class":"facility"}]},{"description":"Acetadote 20%","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500104","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"70594011102","type":"NDC"}],"standard_charges":[{"gross_charge":127.8,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol Liquid","drug_information":{"unit":"10.15","type":"UN"},"code_information":[{"code":"2500110","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121131400","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol","drug_information":{"unit":"325","type":"UN"},"code_information":[{"code":"2500120","type":"CDM"},{"code":"637","type":"RC"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"setting":"both","billing_class":"facility"}]},{"description":"TylenoL","drug_information":{"unit":"325","type":"UN"},"code_information":[{"code":"2500130","type":"CDM"},{"code":"637","type":"RC"},{"code":"50580045811","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Mucomyst 10%","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500150","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517750425","type":"NDC"}],"standard_charges":[{"gross_charge":62.4,"setting":"both","billing_class":"facility"}]},{"description":"Diamox","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2500160","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":189.0,"setting":"both","billing_class":"facility"}]},{"description":"Ofirmev","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500161","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781315606","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol w/Codeine 120-12mg/5mL","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2500176","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121050400","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2500180","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904673061","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tylenol","drug_information":{"unit":"650","type":"UN"},"code_information":[{"code":"2500190","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802073033","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ACETIC ACID 3%","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500240","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Diamox","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2500250","type":"CDM"},{"code":"637","type":"RC"},{"code":"70756072111","type":"NDC"}],"standard_charges":[{"gross_charge":16.56,"setting":"both","billing_class":"facility"}]},{"description":"Diamox Sequels","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2500255","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729033101","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"setting":"both","billing_class":"facility"}]},{"description":"ACIDOPHILUS-OUTPT PHA STOCK","drug_information":{"unit":"175","type":"UN"},"code_information":[{"code":"2500258","type":"CDM"},{"code":"637","type":"RC"},{"code":"40985022928","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Activated Charcoal in Water","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"2500262","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689020108","type":"NDC"}],"standard_charges":[{"gross_charge":242.94,"setting":"both","billing_class":"facility"}]},{"description":"Zovirax","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2500290","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904578961","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zovirax","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500291","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":30.35,"setting":"both","billing_class":"facility"}]},{"description":"Adenocard","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":33.3,"setting":"both","billing_class":"facility"}]},{"description":"Kadcyla","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2500301","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"gross_charge":19948.15,"setting":"both","billing_class":"facility"}]},{"description":"AKYNZEO 235-0.25 MG VIAL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500303","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1454","type":"HCPCS"},{"code":"69639010201","type":"NDC"}],"standard_charges":[{"gross_charge":3757.49,"setting":"both","billing_class":"facility"}]},{"description":"ADUHELM","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"2500304","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0172","type":"HCPCS"},{"code":"64406010101","type":"NDC"}],"standard_charges":[{"gross_charge":2636.7,"setting":"both","billing_class":"facility"}]},{"description":"Leqembi","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500305","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0174","type":"HCPCS"},{"code":"62856021501","type":"NDC"}],"standard_charges":[{"gross_charge":3521.16,"setting":"both","billing_class":"facility"}]},{"description":"Leqembi","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500306","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0174","type":"HCPCS"},{"code":"62856021201","type":"NDC"}],"standard_charges":[{"gross_charge":1401.46,"setting":"both","billing_class":"facility"}]},{"description":"Kadcyla","drug_information":{"unit":"160","type":"ME"},"code_information":[{"code":"2500307","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":28725.3,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEIN 25%","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500317","type":"CDM"},{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":420.0,"setting":"both","billing_class":"facility"}]},{"description":"Ventolin HFA","drug_information":{"unit":"8","type":"GM"},"code_information":[{"code":"2500330","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":136.32,"setting":"both","billing_class":"facility"}]},{"description":"Proventil 0.083%","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500370","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Fosamax","drug_information":{"unit":"70","type":"UN"},"code_information":[{"code":"2500437","type":"CDM"},{"code":"637","type":"RC"},{"code":"64980034214","type":"NDC"}],"standard_charges":[{"gross_charge":122.88,"setting":"both","billing_class":"facility"}]},{"description":"Lemtrada","drug_information":{"unit":"1.2","type":"ML"},"code_information":[{"code":"2500441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0202","type":"HCPCS"},{"code":"58468020001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zyloprim","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2500470","type":"CDM"},{"code":"637","type":"RC"},{"code":"70710120901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zyloprim","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2500480","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378018101","type":"NDC"}],"standard_charges":[{"gross_charge":5.52,"setting":"both","billing_class":"facility"}]},{"description":"Ayr Saline Nasal 0.5oz Gel","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500485","type":"CDM"},{"code":"637","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"gross_charge":18.36,"setting":"both","billing_class":"facility"}]},{"description":"Xanax","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2500490","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Xanax","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2500500","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862067701","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"setting":"both","billing_class":"facility"}]},{"description":"Cathflo Activase","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2500525","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":1058.1,"setting":"both","billing_class":"facility"}]},{"description":"Drysol 20%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500551","type":"CDM"},{"code":"252","type":"RC"},{"code":"00096070737","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"setting":"both","billing_class":"facility"}]},{"description":"ARALAST NP","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500570","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0256","type":"HCPCS"},{"code":"00944280303","type":"NDC"}],"standard_charges":[{"gross_charge":1430.0,"setting":"both","billing_class":"facility"}]},{"description":"ARALAST NP","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500571","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0256","type":"HCPCS"},{"code":"00944280404","type":"NDC"}],"standard_charges":[{"gross_charge":2860.0,"setting":"both","billing_class":"facility"}]},{"description":"GLASSIA","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500572","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0257","type":"HCPCS"},{"code":"00944288401","type":"NDC"}],"standard_charges":[{"gross_charge":3791.04,"setting":"both","billing_class":"facility"}]},{"description":"Symmetrel","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2500620","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904704206","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"setting":"both","billing_class":"facility"}]},{"description":"Amikin Vial","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500721","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"gross_charge":85.8,"setting":"both","billing_class":"facility"}]},{"description":"Aminophylline","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500800","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":99.12,"setting":"both","billing_class":"facility"}]},{"description":"CLINIMIX E 5%-20%","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500826","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00338114803","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Clinimix 5%-20% 1,000mL","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500827","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338113803","type":"NDC"}],"standard_charges":[{"gross_charge":290.16,"setting":"both","billing_class":"facility"}]},{"description":"Clinimix E 5%-20%","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500828","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338112504","type":"NDC"}],"standard_charges":[{"gross_charge":562.65,"setting":"both","billing_class":"facility"}]},{"description":"Clinimix 5%-20% 2,000mL","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500829","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338110104","type":"NDC"}],"standard_charges":[{"gross_charge":527.32,"setting":"both","billing_class":"facility"}]},{"description":"Clinimix E 4.25%-5%","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500831","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338111304","type":"NDC"}],"standard_charges":[{"gross_charge":516.84,"setting":"both","billing_class":"facility"}]},{"description":"Clinimix 4.25%-5%","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500833","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338108904","type":"NDC"}],"standard_charges":[{"gross_charge":480.06,"setting":"both","billing_class":"facility"}]},{"description":"Nexterone","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2500882","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":276.84,"setting":"both","billing_class":"facility"}]},{"description":"Cordarone","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500883","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"AMIODARONE HCL","drug_information":{"unit":"9","type":"ML"},"code_information":[{"code":"2500884","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061609","type":"NDC"}],"standard_charges":[{"gross_charge":32.82,"setting":"both","billing_class":"facility"}]},{"description":"Barhemsys","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500888","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0184","type":"HCPCS"},{"code":"71390012521","type":"NDC"}],"standard_charges":[{"gross_charge":250.02,"setting":"both","billing_class":"facility"}]},{"description":"Endep","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2500890","type":"CDM"},{"code":"637","type":"RC"},{"code":"29300041901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Endep","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2500900","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268003815","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Norvasc","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2500914","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904636961","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Norvasc","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2500915","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687048801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Norvasc","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2500916","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687049601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lac-Hydrin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2500951","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399014008","type":"NDC"}],"standard_charges":[{"gross_charge":20.7,"setting":"both","billing_class":"facility"}]},{"description":"Amoxil","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500990","type":"CDM"},{"code":"637","type":"RC"},{"code":"00143988801","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"setting":"both","billing_class":"facility"}]},{"description":"Augmentin 250mg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501021","type":"CDM"},{"code":"637","type":"RC"},{"code":"00781187431","type":"NDC"}],"standard_charges":[{"gross_charge":35.52,"setting":"both","billing_class":"facility"}]},{"description":"Augmentin 500mg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501022","type":"CDM"},{"code":"637","type":"RC"},{"code":"00781183101","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"setting":"both","billing_class":"facility"}]},{"description":"Augmentin 875mg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501023","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"gross_charge":30.42,"setting":"both","billing_class":"facility"}]},{"description":"Amoxicillin","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2501030","type":"CDM"},{"code":"637","type":"RC"},{"code":"00143988901","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"setting":"both","billing_class":"facility"}]},{"description":"Amoxil Chewable","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2501035","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093226801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Augmentin","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2501040","type":"CDM"},{"code":"637","type":"RC"},{"code":"59651002601","type":"NDC"}],"standard_charges":[{"gross_charge":314.1,"setting":"both","billing_class":"facility"}]},{"description":"Amoxil","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2501060","type":"CDM"},{"code":"637","type":"RC"},{"code":"00781202001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Amoxil","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2501080","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862001701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Adderall","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2501125","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406889101","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"setting":"both","billing_class":"facility"}]},{"description":"Unasyn","drug_information":{"unit":"1.5","type":"UN"},"code_information":[{"code":"2501130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567021010","type":"NDC"}],"standard_charges":[{"gross_charge":57.24,"setting":"both","billing_class":"facility"}]},{"description":"Omnipen-N","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2501141","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"setting":"both","billing_class":"facility"}]},{"description":"Omnipen-N","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501150","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67850002110","type":"NDC"}],"standard_charges":[{"gross_charge":47.4,"setting":"both","billing_class":"facility"}]},{"description":"Ampicillin Sodium","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2501260","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"65219001401","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"Unasyn","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2501270","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":87.6,"setting":"both","billing_class":"facility"}]},{"description":"Ampicillin","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2501280","type":"CDM"},{"code":"637","type":"RC"},{"code":"00781214501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Omnipen-N","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2501290","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781340778","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"setting":"both","billing_class":"facility"}]},{"description":"Ben Gay","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501315","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896011603","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"setting":"both","billing_class":"facility"}]},{"description":"PRESERVISION AREDS 2 SOFTGEL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501330","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208069760","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"HAIR, SKIN AND NAILS CAPLET","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501345","type":"CDM"},{"code":"250","type":"RC"},{"code":"74312007580","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ALOE VESTA 56g 2 oz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501350","type":"CDM"},{"code":"250","type":"RC"},{"code":"43553324908","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"FLEET ENEMA 133mL 4.5oz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501355","type":"CDM"},{"code":"250","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Saphnelo","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2501370","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0491","type":"HCPCS"},{"code":"00310304000","type":"NDC"}],"standard_charges":[{"gross_charge":24002.82,"setting":"both","billing_class":"facility"}]},{"description":"Eloctate","drug_information":{"unit":"4000","type":"UN"},"code_information":[{"code":"2501381","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7205","type":"HCPCS"},{"code":"71104080801","type":"NDC"}],"standard_charges":[{"gross_charge":47993.80,"setting":"both","billing_class":"facility"}]},{"description":"THYMOGLOBULIN","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2501385","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7511","type":"HCPCS"},{"code":"58468008001","type":"NDC"}],"standard_charges":[{"gross_charge":5330.8,"setting":"both","billing_class":"facility"}]},{"description":"ATGAM","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2501386","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7504","type":"HCPCS"},{"code":"00009722401","type":"NDC"}],"standard_charges":[{"gross_charge":20224.24,"setting":"both","billing_class":"facility"}]},{"description":"Eliquis","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2501391","type":"CDM"},{"code":"252","type":"RC"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"gross_charge":59.46,"setting":"both","billing_class":"facility"}]},{"description":"Eliquis","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2501392","type":"CDM"},{"code":"252","type":"RC"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"gross_charge":59.46,"setting":"both","billing_class":"facility"}]},{"description":"Iopidine 1%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501394","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667020001","type":"NDC"}],"standard_charges":[{"gross_charge":154.08,"setting":"both","billing_class":"facility"}]},{"description":"Emend","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2501398","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"13668059181","type":"NDC"}],"standard_charges":[{"gross_charge":207.24,"setting":"both","billing_class":"facility"}]},{"description":"Cinvanti","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"2501399","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":2451.18,"setting":"both","billing_class":"facility"}]},{"description":"Abilify","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2501401","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332009731","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Abilify","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2501403","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332009830","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Abilify","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2501404","type":"CDM"},{"code":"637","type":"RC"},{"code":"31722082730","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Abilify","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2501405","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332010030","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ARGATROBAN 50 MG/50ML-0.9%NACL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2501406","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0883","type":"HCPCS"},{"code":"00143955901","type":"NDC"}],"standard_charges":[{"gross_charge":570.9,"setting":"both","billing_class":"facility"}]},{"description":"Liquid Tears","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501410","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385000605","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"setting":"both","billing_class":"facility"}]},{"description":"Abilify Maintena","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2501411","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001871","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Abilify Maintena","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2501412","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001970","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ARSENIC TRIOXIDE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2501429","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"54879002710","type":"NDC"}],"standard_charges":[{"gross_charge":3052.5,"setting":"both","billing_class":"facility"}]},{"description":"Lubrifresh PM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501430","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":47.22,"setting":"both","billing_class":"facility"}]},{"description":"BIOTENE ORALBALANCE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501431","type":"CDM"},{"code":"250","type":"RC"},{"code":"48582051201","type":"NDC"}],"standard_charges":[{"gross_charge":32.7,"setting":"both","billing_class":"facility"}]},{"description":"ASCOR MDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2501468","type":"CDM"},{"code":"250","type":"RC"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":30.07,"setting":"both","billing_class":"facility"}]},{"description":"Aspirin R","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2501530","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574703412","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"setting":"both","billing_class":"facility"}]},{"description":"Aspirin","drug_information":{"unit":"325","type":"UN"},"code_information":[{"code":"2501540","type":"CDM"},{"code":"637","type":"RC"},{"code":"66553000101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Aspirin Enteric Coated","drug_information":{"unit":"325","type":"UN"},"code_information":[{"code":"2501542","type":"CDM"},{"code":"637","type":"RC"},{"code":"46122059602","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Aspirin Enteric Coated","drug_information":{"unit":"81","type":"UN"},"code_information":[{"code":"2501544","type":"CDM"},{"code":"637","type":"RC"},{"code":"00536123441","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Aspirin","drug_information":{"unit":"81","type":"UN"},"code_information":[{"code":"2501570","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904679480","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tenormin","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2501600","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079068420","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"setting":"both","billing_class":"facility"}]},{"description":"Tenormin","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2501602","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079075920","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tecentriq","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2501603","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":50633.14,"setting":"both","billing_class":"facility"}]},{"description":"Lipitor","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2501614","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084009801","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"setting":"both","billing_class":"facility"}]},{"description":"Lipitor","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2501615","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268009515","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Atropine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2501630","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":67.38,"setting":"both","billing_class":"facility"}]},{"description":"Atropine Bolus","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2501650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":61.62,"setting":"both","billing_class":"facility"}]},{"description":"Atrovent 0.06% 15ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501652","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":193.32,"setting":"both","billing_class":"facility"}]},{"description":"Atropisol 1%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501670","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505622601","type":"NDC"}],"standard_charges":[{"gross_charge":156.3,"setting":"both","billing_class":"facility"}]},{"description":"DuoDote 2.7mL Auto-Injector","drug_information":{"unit":"2.7","type":"ML"},"code_information":[{"code":"2501671","type":"CDM"},{"code":"250","type":"RC"},{"code":"11704062001","type":"NDC"}],"standard_charges":[{"gross_charge":304.86,"setting":"both","billing_class":"facility"}]},{"description":"Lipitor","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2501685","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084009701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Avapro","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2501704","type":"CDM"},{"code":"637","type":"RC"},{"code":"33342004807","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"setting":"both","billing_class":"facility"}]},{"description":"Avitene Non-Woven Web","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501706","type":"CDM"},{"code":"250","type":"RC"},{"code":"00998101009","type":"NDC"}],"standard_charges":[{"gross_charge":1442.62,"setting":"both","billing_class":"facility"}]},{"description":"Bavencio","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2501710","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9023","type":"HCPCS"},{"code":"44087353501","type":"NDC"}],"standard_charges":[{"gross_charge":10067.4,"setting":"both","billing_class":"facility"}]},{"description":"Vidaza","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2501725","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":172.26,"setting":"both","billing_class":"facility"}]},{"description":"Imuran","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2501730","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"setting":"both","billing_class":"facility"}]},{"description":"Astelin 0.1%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501734","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"gross_charge":244.08,"setting":"both","billing_class":"facility"}]},{"description":"Zithromax","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501735","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069305175","type":"NDC"}],"standard_charges":[{"gross_charge":422.4,"setting":"both","billing_class":"facility"}]},{"description":"Zithromax","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2501736","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"}]},{"description":"Zithromax","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2501737","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268007415","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zithromax","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2501738","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093202623","type":"NDC"}],"standard_charges":[{"gross_charge":142.2,"setting":"both","billing_class":"facility"}]},{"description":"Zithromax","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2501739","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093202723","type":"NDC"}],"standard_charges":[{"gross_charge":142.2,"setting":"both","billing_class":"facility"}]},{"description":"BRILINTA","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"2501769","type":"CDM"},{"code":"250","type":"RC"},{"code":"00186077739","type":"NDC"}],"standard_charges":[{"gross_charge":45.12,"setting":"both","billing_class":"facility"}]},{"description":"Brilinta","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2501770","type":"CDM"},{"code":"250","type":"RC"},{"code":"00186077660","type":"NDC"}],"standard_charges":[{"gross_charge":45.12,"setting":"both","billing_class":"facility"}]},{"description":"Azactam","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2501771","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00409083001","type":"NDC"}],"standard_charges":[{"gross_charge":338.87,"setting":"both","billing_class":"facility"}]},{"description":"Azactam","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501772","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323040101","type":"NDC"}],"standard_charges":[{"gross_charge":133.38,"setting":"both","billing_class":"facility"}]},{"description":"Tice BCG","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2501777","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9030","type":"HCPCS"},{"code":"00052060202","type":"NDC"}],"standard_charges":[{"gross_charge":1019.28,"setting":"both","billing_class":"facility"}]},{"description":"Bacitracin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2501790","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385006003","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"setting":"both","billing_class":"facility"}]},{"description":"Neosporin Foil Pack","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501815","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Neosporin Gu Irrigant","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2501850","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822120102","type":"NDC"}],"standard_charges":[{"gross_charge":65.58,"setting":"both","billing_class":"facility"}]},{"description":"Gablofen","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2501858","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0475","type":"HCPCS"},{"code":"66794015701","type":"NDC"}],"standard_charges":[{"gross_charge":5082.9,"setting":"both","billing_class":"facility"}]},{"description":"Lioresal","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2501859","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084086801","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"setting":"both","billing_class":"facility"}]},{"description":"Lioresal","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2501860","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268010615","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Gablofen","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2501861","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0475","type":"HCPCS"},{"code":"66794015501","type":"NDC"}],"standard_charges":[{"gross_charge":1396.28,"setting":"both","billing_class":"facility"}]},{"description":"Sulfamethoxazole/Trimethoprim Susp 200mg/40mg","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2501862","type":"CDM"},{"code":"250","type":"RC"},{"code":"17856049601","type":"NDC"}],"standard_charges":[{"gross_charge":23.34,"setting":"both","billing_class":"facility"}]},{"description":"Gablofen","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2501863","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0476","type":"HCPCS"},{"code":"66794015101","type":"NDC"}],"standard_charges":[{"gross_charge":527.52,"setting":"both","billing_class":"facility"}]},{"description":"Septra 400/80mg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501868","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268072815","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"BSS Eye Solution","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2501875","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065179504","type":"NDC"}],"standard_charges":[{"gross_charge":212.34,"setting":"both","billing_class":"facility"}]},{"description":"BSS Plus","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2501877","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065080050","type":"NDC"}],"standard_charges":[{"gross_charge":596.94,"setting":"both","billing_class":"facility"}]},{"description":"E-Z-PAQUE","drug_information":{"unit":"176","type":"GM"},"code_information":[{"code":"2501900","type":"CDM"},{"code":"255","type":"RC"},{"code":"32909075003","type":"NDC"}],"standard_charges":[{"gross_charge":29.34,"setting":"both","billing_class":"facility"}]},{"description":"LIQUID POLIBAR PLUS","drug_information":{"unit":"1900","type":"ML"},"code_information":[{"code":"2501901","type":"CDM"},{"code":"255","type":"RC"},{"code":"32909016802","type":"NDC"}],"standard_charges":[{"gross_charge":212.7,"setting":"both","billing_class":"facility"}]},{"description":"VARIBAR PUDDING","drug_information":{"unit":"230","type":"ML"},"code_information":[{"code":"2501902","type":"CDM"},{"code":"255","type":"RC"},{"code":"32909012522","type":"NDC"}],"standard_charges":[{"gross_charge":302.1,"setting":"both","billing_class":"facility"}]},{"description":"READI-CAT 2","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"2501903","type":"CDM"},{"code":"255","type":"RC"},{"code":"32909071103","type":"NDC"}],"standard_charges":[{"gross_charge":24.24,"setting":"both","billing_class":"facility"}]},{"description":"E-Z DISK","drug_information":{"unit":"700","type":"ME"},"code_information":[{"code":"2501904","type":"CDM"},{"code":"255","type":"RC"},{"code":"10361077831","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"setting":"both","billing_class":"facility"}]},{"description":"DOTAREM","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2501906","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200003","type":"NDC"}],"standard_charges":[{"gross_charge":603.6,"setting":"both","billing_class":"facility"}]},{"description":"Treanda","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2501953","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"63459039008","type":"NDC"}],"standard_charges":[{"gross_charge":2129.32,"setting":"both","billing_class":"facility"}]},{"description":"Treanda","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2501963","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"63459039120","type":"NDC"}],"standard_charges":[{"gross_charge":7743.05,"setting":"both","billing_class":"facility"}]},{"description":"Benlysta","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2501972","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401010101","type":"NDC"}],"standard_charges":[{"gross_charge":3491.12,"setting":"both","billing_class":"facility"}]},{"description":"Benlysta","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2501992","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401010201","type":"NDC"}],"standard_charges":[{"gross_charge":10578.5,"setting":"both","billing_class":"facility"}]},{"description":"BELLADONNA-OPIUM 16.2-30MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2501997","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574704512","type":"NDC"}],"standard_charges":[{"gross_charge":165.12,"setting":"both","billing_class":"facility"}]},{"description":"Lotensin","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2502025","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268011015","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"setting":"both","billing_class":"facility"}]},{"description":"Bicitra","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2502097","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":38.04,"setting":"both","billing_class":"facility"}]},{"description":"Cogentin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502155","type":"CDM"},{"code":"637","type":"RC"},{"code":"00603243421","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cogentin","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502180","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"00143972905","type":"NDC"}],"standard_charges":[{"gross_charge":360.0,"setting":"both","billing_class":"facility"}]},{"description":"Tessalon Pearle","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2502325","type":"CDM"},{"code":"637","type":"RC"},{"code":"69452014320","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"}]},{"description":"Betamethasone Sod Phos/Ace","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2502472","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":231.06,"setting":"both","billing_class":"facility"}]},{"description":"Diprosone 0.05%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00472038015","type":"NDC"}],"standard_charges":[{"gross_charge":225.3,"setting":"both","billing_class":"facility"}]},{"description":"Urecholine","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2502620","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832051200","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"setting":"both","billing_class":"facility"}]},{"description":"MVASI","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2502641","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":3703.20,"setting":"both","billing_class":"facility"}]},{"description":"MVASI","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"2502642","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":13466.05,"setting":"both","billing_class":"facility"}]},{"description":"Avastin","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2502643","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":4383.17,"setting":"both","billing_class":"facility"}]},{"description":"Avastin","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"2502645","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":15938.8,"setting":"both","billing_class":"facility"}]},{"description":"Bicillin LA","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":1379.68,"setting":"both","billing_class":"facility"}]},{"description":"Zinplava","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2502660","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0565","type":"HCPCS"},{"code":"00006302500","type":"NDC"}],"standard_charges":[{"gross_charge":19000.0,"setting":"both","billing_class":"facility"}]},{"description":"Lumigan 0.01%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502666","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023320503","type":"NDC"}],"standard_charges":[{"gross_charge":1396.74,"setting":"both","billing_class":"facility"}]},{"description":"Dulcolax R","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2502700","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574705012","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dulcolax","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2502710","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904640761","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Blenoxane","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2502760","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"00143924001","type":"NDC"}],"standard_charges":[{"gross_charge":108.36,"setting":"both","billing_class":"facility"}]},{"description":"Bleomycin","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2502762","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"71288010720","type":"NDC"}],"standard_charges":[{"gross_charge":196.98,"setting":"both","billing_class":"facility"}]},{"description":"Velcade","drug_information":{"unit":"3.5","type":"UN"},"code_information":[{"code":"2502785","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":252.0,"setting":"both","billing_class":"facility"}]},{"description":"XEOMIN","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2502790","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0588","type":"HCPCS"},{"code":"00259160501","type":"NDC"}],"standard_charges":[{"gross_charge":1474.0,"setting":"both","billing_class":"facility"}]},{"description":"Botox","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2502796","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"gross_charge":3553.0,"setting":"both","billing_class":"facility"}]},{"description":"Adcetris","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2502806","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"51144005001","type":"NDC"}],"standard_charges":[{"gross_charge":54900.0,"setting":"both","billing_class":"facility"}]},{"description":"Rexulti","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502808","type":"CDM"},{"code":"252","type":"RC"},{"code":"59148003713","type":"NDC"}],"standard_charges":[{"gross_charge":294.3,"setting":"both","billing_class":"facility"}]},{"description":"Alphagan 0.2%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502815","type":"CDM"},{"code":"637","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":78.6,"setting":"both","billing_class":"facility"}]},{"description":"Azopt 1%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502817","type":"CDM"},{"code":"637","type":"RC"},{"code":"68682046410","type":"NDC"}],"standard_charges":[{"gross_charge":545.7,"setting":"both","billing_class":"facility"}]},{"description":"BSS","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2502870","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":72.96,"setting":"both","billing_class":"facility"}]},{"description":"Pulmicort","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502875","type":"CDM"},{"code":"637","type":"RC"},{"code":"00487960130","type":"NDC"}],"standard_charges":[{"gross_charge":26.39,"setting":"both","billing_class":"facility"}]},{"description":"Pulmicort","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502876","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":67.2,"setting":"both","billing_class":"facility"}]},{"description":"Pulmicort","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502877","type":"CDM"},{"code":"637","type":"RC"},{"code":"69097032187","type":"NDC"}],"standard_charges":[{"gross_charge":36.18,"setting":"both","billing_class":"facility"}]},{"description":"Bumex","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2502884","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832054011","type":"NDC"}],"standard_charges":[{"gross_charge":14.58,"setting":"both","billing_class":"facility"}]},{"description":"Bumex","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2502885","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"72205010207","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"setting":"both","billing_class":"facility"}]},{"description":"Bumex","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2502886","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268013215","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"setting":"both","billing_class":"facility"}]},{"description":"Bumex","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2502890","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832054111","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"setting":"both","billing_class":"facility"}]},{"description":"Bumex","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2502900","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine 0.25% 30ML VIAL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2502940","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine 0.25%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2502941","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"setting":"both","billing_class":"facility"}]},{"description":"Bupivacaine HCl 0.5%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2502942","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine 0.5%","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2502945","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":9.86,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine 0.75% Spinal","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2502946","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine w/epi 0.5%","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2502947","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":68.58,"setting":"both","billing_class":"facility"}]},{"description":"Marcaine w/epi 0.25%","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2502990","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"setting":"both","billing_class":"facility"}]},{"description":"Exparel 1.3%","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2502991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":2192.80,"setting":"both","billing_class":"facility"}]},{"description":"Exparel 1.3% 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2502992","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"gross_charge":1447.74,"setting":"both","billing_class":"facility"}]},{"description":"Suboxone 8/2mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503003","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"50268014515","type":"NDC"}],"standard_charges":[{"gross_charge":50.76,"setting":"both","billing_class":"facility"}]},{"description":"Suboxone 2/0.5mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503004","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268014415","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"setting":"both","billing_class":"facility"}]},{"description":"Wellbutrin","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2503005","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268014215","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"setting":"both","billing_class":"facility"}]},{"description":"Wellbutrin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2503006","type":"CDM"},{"code":"637","type":"RC"},{"code":"23155019201","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"setting":"both","billing_class":"facility"}]},{"description":"Wellbutrin SR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2503007","type":"CDM"},{"code":"637","type":"RC"},{"code":"31722006601","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"setting":"both","billing_class":"facility"}]},{"description":"Wellbutrin SR","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2503008","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Buspar","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2503020","type":"CDM"},{"code":"637","type":"RC"},{"code":"29300024401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Buspar","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2503021","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079098620","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"setting":"both","billing_class":"facility"}]},{"description":"Buspar","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2503022","type":"CDM"},{"code":"637","type":"RC"},{"code":"29300047701","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"setting":"both","billing_class":"facility"}]},{"description":"Stadol","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2503068","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"00409162301","type":"NDC"}],"standard_charges":[{"gross_charge":44.52,"setting":"both","billing_class":"facility"}]},{"description":"RUCONEST","drug_information":{"unit":"2100","type":"UN"},"code_information":[{"code":"2503073","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0596","type":"HCPCS"},{"code":"71274035002","type":"NDC"}],"standard_charges":[{"gross_charge":36337.5,"setting":"both","billing_class":"facility"}]},{"description":"Berinert","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2503074","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0597","type":"HCPCS"},{"code":"63833082502","type":"NDC"}],"standard_charges":[{"gross_charge":21358.05,"setting":"both","billing_class":"facility"}]},{"description":"Jevtana","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2503076","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":64614.28,"setting":"both","billing_class":"facility"}]},{"description":"CAFFEINE-SOD BENZOAT 500 MG/2 ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2503077","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517250210","type":"NDC"}],"standard_charges":[{"gross_charge":204.3,"setting":"both","billing_class":"facility"}]},{"description":"Caffeine Citrate","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2503078","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"72485010401","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"}]},{"description":"No Doz Maximum Strength","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2503079","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122045773","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Phoslo","drug_information":{"unit":"667","type":"UN"},"code_information":[{"code":"2503085","type":"CDM"},{"code":"637","type":"RC"},{"code":"69097086283","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"setting":"both","billing_class":"facility"}]},{"description":"Caltrate-600/Vit D","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503089","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555001700","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Rocaltrol","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2503105","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"setting":"both","billing_class":"facility"}]},{"description":"Calcium Chloride 10%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2503115","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"setting":"both","billing_class":"facility"}]},{"description":"Calamine","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503160","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"setting":"both","billing_class":"facility"}]},{"description":"CeleXA","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2503162","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Kyprolis","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2503164","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010201","type":"NDC"}],"standard_charges":[{"gross_charge":8843.0,"setting":"both","billing_class":"facility"}]},{"description":"Kyprolis","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2503166","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010101","type":"NDC"}],"standard_charges":[{"gross_charge":17685.95,"setting":"both","billing_class":"facility"}]},{"description":"Calcium Gluconate 10%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2503200","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"00143918025","type":"NDC"}],"standard_charges":[{"gross_charge":60.12,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM GLUC 1,000MG/50ML-NACL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2503201","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"80830236209","type":"NDC"}],"standard_charges":[{"gross_charge":72.18,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM GLU 2,000MG/100ML-NACL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2503202","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"80830236309","type":"NDC"}],"standard_charges":[{"gross_charge":97.24,"setting":"both","billing_class":"facility"}]},{"description":"Calcium Chloride 10%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2503210","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"}]},{"description":"Miacalcin Nasal 3.7mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503225","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":339.78,"setting":"both","billing_class":"facility"}]},{"description":"Calcium Disodium Versenate","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2503250","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0600","type":"HCPCS"},{"code":"99207024005","type":"NDC"}],"standard_charges":[{"gross_charge":24234.62,"setting":"both","billing_class":"facility"}]},{"description":"Miacalcin MDV","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2503270","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":4441.25,"setting":"both","billing_class":"facility"}]},{"description":"Tums","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2503296","type":"CDM"},{"code":"637","type":"RC"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"QUTENZA 8% KIT (1 PATCH)","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2503300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7336","type":"HCPCS"},{"code":"72512092801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Camptosar","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2503325","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"68001048022","type":"NDC"}],"standard_charges":[{"gross_charge":85.68,"setting":"both","billing_class":"facility"}]},{"description":"Capoten","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2503380","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687031521","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"setting":"both","billing_class":"facility"}]},{"description":"Miostat 0.01%","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2503400","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065002315","type":"NDC"}],"standard_charges":[{"gross_charge":268.08,"setting":"both","billing_class":"facility"}]},{"description":"Sinemet 10-100","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2503407","type":"CDM"},{"code":"637","type":"RC"},{"code":"51862085501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sinemet CR 50-200","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2503408","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084028201","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"setting":"both","billing_class":"facility"}]},{"description":"Tegretol","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2503450","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084044401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Hemabate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2503460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"gross_charge":442.89,"setting":"both","billing_class":"facility"}]},{"description":"Carbamide","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503470","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"setting":"both","billing_class":"facility"}]},{"description":"Paraplatin MDV","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"2503490","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":320.76,"setting":"both","billing_class":"facility"}]},{"description":"CARBOplatin MDV","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2503499","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":211.8,"setting":"both","billing_class":"facility"}]},{"description":"REFRESH LIQUIGEL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2503500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023920515","type":"NDC"}],"standard_charges":[{"gross_charge":57.3,"setting":"both","billing_class":"facility"}]},{"description":"Carnitor","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2503512","type":"CDM"},{"code":"250","type":"RC"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"gross_charge":233.22,"setting":"both","billing_class":"facility"}]},{"description":"Coreg","drug_information":{"unit":"12.5","type":"UN"},"code_information":[{"code":"2503516","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904630261","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coreg","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2503517","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904630361","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coreg","drug_information":{"unit":"3.125","type":"UN"},"code_information":[{"code":"2503518","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904630061","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coreg","drug_information":{"unit":"6.25","type":"UN"},"code_information":[{"code":"2503519","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084085401","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"setting":"both","billing_class":"facility"}]},{"description":"Amondys-45","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2503540","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1426","type":"HCPCS"},{"code":"60923022702","type":"NDC"}],"standard_charges":[{"gross_charge":8000.0,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB (REGN10933) (EUA)","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"2503550","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB (REGN10933) (EUA)","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2503551","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Kefzol","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503580","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00143992490","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"setting":"both","billing_class":"facility"}]},{"description":"Kefzol","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2503581","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":43.86,"setting":"both","billing_class":"facility"}]},{"description":"Kefzol","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2503646","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310311","type":"NDC"}],"standard_charges":[{"gross_charge":72.9,"setting":"both","billing_class":"facility"}]},{"description":"Kefzol","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2503648","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":82.08,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROXIME","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2503700","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"gross_charge":26.4,"setting":"both","billing_class":"facility"}]},{"description":"Omnicef","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2503703","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862021860","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"setting":"both","billing_class":"facility"}]},{"description":"Omnicef","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2503706","type":"CDM"},{"code":"637","type":"RC"},{"code":"57237009960","type":"NDC"}],"standard_charges":[{"gross_charge":30.66,"setting":"both","billing_class":"facility"}]},{"description":"Mefoxin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503715","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"Fortaz","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2503742","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"00409508411","type":"NDC"}],"standard_charges":[{"gross_charge":57.3,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2503750","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":19.44,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2503751","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320995","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin 1g","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2503752","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315311","type":"NDC"}],"standard_charges":[{"gross_charge":109.32,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin 2g","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2503753","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315511","type":"NDC"}],"standard_charges":[{"gross_charge":145.74,"setting":"both","billing_class":"facility"}]},{"description":"Fortaz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503760","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"setting":"both","billing_class":"facility"}]},{"description":"Avycaz 2.5","drug_information":{"unit":"2.5","type":"GM"},"code_information":[{"code":"2503765","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"00456270001","type":"NDC"}],"standard_charges":[{"gross_charge":2175.74,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2503780","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Celebrex","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2503799","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687044701","type":"NDC"}],"standard_charges":[{"gross_charge":14.58,"setting":"both","billing_class":"facility"}]},{"description":"Celebrex","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2503803","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687043601","type":"NDC"}],"standard_charges":[{"gross_charge":27.72,"setting":"both","billing_class":"facility"}]},{"description":"Keflex 250mg/5mL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2503820","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Keflex","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2503830","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Keflex","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2503850","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268015215","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"setting":"both","billing_class":"facility"}]},{"description":"LIBTAYO","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"2503890","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":47730.42,"setting":"both","billing_class":"facility"}]},{"description":"Chloraseptic Sore Throat Lozenge","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2503898","type":"CDM"},{"code":"637","type":"RC"},{"code":"78112001266","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SUCRETS SORE THROAT-COUGH LOZ","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503899","type":"CDM"},{"code":"637","type":"RC"},{"code":"63736001919","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"CEPACOL SORE THROAT-COUGH LOZ","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2503900","type":"CDM"},{"code":"637","type":"RC"},{"code":"63824074416","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"CIMZIA","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2503901","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0717","type":"HCPCS"},{"code":"50474070062","type":"NDC"}],"standard_charges":[{"gross_charge":26997.44,"setting":"both","billing_class":"facility"}]},{"description":"Zyrtec","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2503903","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001043696","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"setting":"both","billing_class":"facility"}]},{"description":"Erbitux","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2503904","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":4422.50,"setting":"both","billing_class":"facility"}]},{"description":"Erbitux","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2503907","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":7837.05,"setting":"both","billing_class":"facility"}]},{"description":"Cherry Syrup","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"2503940","type":"CDM"},{"code":"637","type":"RC"},{"code":"31722093847","type":"NDC"}],"standard_charges":[{"gross_charge":121.98,"setting":"both","billing_class":"facility"}]},{"description":"Librium","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2504000","type":"CDM"},{"code":"637","type":"RC"},{"code":"00555003302","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Librium","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2504090","type":"CDM"},{"code":"637","type":"RC"},{"code":"00555015902","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Thorazine","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2504110","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"00832601800","type":"NDC"}],"standard_charges":[{"gross_charge":45.84,"setting":"both","billing_class":"facility"}]},{"description":"Peridex 0.12%","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2504200","type":"CDM"},{"code":"637","type":"RC"},{"code":"00116200116","type":"NDC"}],"standard_charges":[{"gross_charge":13.16,"setting":"both","billing_class":"facility"}]},{"description":"Peridex 0.12%","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2504201","type":"CDM"},{"code":"250","type":"RC"},{"code":"00116200115","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"setting":"both","billing_class":"facility"}]},{"description":"Thorazine","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2504250","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":198.6,"setting":"both","billing_class":"facility"}]},{"description":"Librium","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2504280","type":"CDM"},{"code":"637","type":"RC"},{"code":"00555015802","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Chloraseptic Spray 1.4%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504304","type":"CDM"},{"code":"637","type":"RC"},{"code":"00536122858","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin D3","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2504381","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555003300","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN D3","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2504382","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618000901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Questran","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2504400","type":"CDM"},{"code":"637","type":"RC"},{"code":"42806026698","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Discovisc 40mg/mL-17mg/Ml","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2504425","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183710","type":"NDC"}],"standard_charges":[{"gross_charge":1747.30,"setting":"both","billing_class":"facility"}]},{"description":"Loprox 0.77%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504485","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802040049","type":"NDC"}],"standard_charges":[{"gross_charge":307.68,"setting":"both","billing_class":"facility"}]},{"description":"Pletal","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2504504","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505252101","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"setting":"both","billing_class":"facility"}]},{"description":"Pletal","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2504505","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093206406","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"setting":"both","billing_class":"facility"}]},{"description":"Sensipar","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2504541","type":"CDM"},{"code":"252","type":"RC"},{"code":"69097041002","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cipro","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2504555","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":21.66,"setting":"both","billing_class":"facility"}]},{"description":"Cipro HC Otic Susp","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504556","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758008770","type":"NDC"}],"standard_charges":[{"gross_charge":1856.36,"setting":"both","billing_class":"facility"}]},{"description":"Cipro","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2504557","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":27.48,"setting":"both","billing_class":"facility"}]},{"description":"Cipro","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2504560","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904708361","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ciloxan 0.3%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504562","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"setting":"both","billing_class":"facility"}]},{"description":"Ciloxan 0.3%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504564","type":"CDM"},{"code":"637","type":"RC"},{"code":"00078084101","type":"NDC"}],"standard_charges":[{"gross_charge":1384.57,"setting":"both","billing_class":"facility"}]},{"description":"Ciprodex Otic 0.3%/0.1%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504566","type":"CDM"},{"code":"637","type":"RC"},{"code":"72485062513","type":"NDC"}],"standard_charges":[{"gross_charge":540.84,"setting":"both","billing_class":"facility"}]},{"description":"Nimbex","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2504573","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069015110","type":"NDC"}],"standard_charges":[{"gross_charge":1785.3,"setting":"both","billing_class":"facility"}]},{"description":"Nimbex","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2504574","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315295","type":"NDC"}],"standard_charges":[{"gross_charge":189.78,"setting":"both","billing_class":"facility"}]},{"description":"Platinol","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2504580","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":72.24,"setting":"both","billing_class":"facility"}]},{"description":"Platinol MDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2504590","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"00143950401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"CITALOPRAM *OUTPATIENT STOCK*","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2504591","type":"CDM"},{"code":"637","type":"RC"},{"code":"13668001101","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"setting":"both","billing_class":"facility"}]},{"description":"CeleXA","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2504595","type":"CDM"},{"code":"637","type":"RC"},{"code":"13668000901","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"setting":"both","billing_class":"facility"}]},{"description":"CLADRIBINE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2504600","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"00143987101","type":"NDC"}],"standard_charges":[{"gross_charge":484.8,"setting":"both","billing_class":"facility"}]},{"description":"Cleocin","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2504640","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084024301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cleocin Pediatric","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2504656","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862059601","type":"NDC"}],"standard_charges":[{"gross_charge":230.88,"setting":"both","billing_class":"facility"}]},{"description":"Cleocin","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2504661","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":89.04,"setting":"both","billing_class":"facility"}]},{"description":"Cleocin","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2504662","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":108.72,"setting":"both","billing_class":"facility"}]},{"description":"Cleocin","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"2504700","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":25.56,"setting":"both","billing_class":"facility"}]},{"description":"Temovate CR 0.05%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504750","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001604","type":"NDC"}],"standard_charges":[{"gross_charge":55.86,"setting":"both","billing_class":"facility"}]},{"description":"Catapress","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2504807","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"facility"}]},{"description":"Klonopin","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2504808","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Klonopin","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2504809","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687055501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Catapres-TTS 1","drug_information":{"unit":"0.1","type":"UN"},"code_information":[{"code":"2504810","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591350804","type":"NDC"}],"standard_charges":[{"gross_charge":198.72,"setting":"both","billing_class":"facility"}]},{"description":"Klonopin ODT","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2504811","type":"CDM"},{"code":"637","type":"RC"},{"code":"49884030802","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"setting":"both","billing_class":"facility"}]},{"description":"Catapres","drug_information":{"unit":"0.1","type":"UN"},"code_information":[{"code":"2504820","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Catapres-TTS 2","drug_information":{"unit":"0.2","type":"UN"},"code_information":[{"code":"2504840","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817061104","type":"NDC"}],"standard_charges":[{"gross_charge":76.94,"setting":"both","billing_class":"facility"}]},{"description":"Catapres-TTS 3","drug_information":{"unit":"0.3","type":"UN"},"code_information":[{"code":"2504850","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591351004","type":"NDC"}],"standard_charges":[{"gross_charge":92.46,"setting":"both","billing_class":"facility"}]},{"description":"Zeasorb AF 2% Powder 43Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504885","type":"CDM"},{"code":"637","type":"RC"},{"code":"46122078929","type":"NDC"}],"standard_charges":[{"gross_charge":18.84,"setting":"both","billing_class":"facility"}]},{"description":"Mycelex Troche","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2504890","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054814622","type":"NDC"}],"standard_charges":[{"gross_charge":20.64,"setting":"both","billing_class":"facility"}]},{"description":"Lotrimin Cream 1%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2504970","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672200202","type":"NDC"}],"standard_charges":[{"gross_charge":43.56,"setting":"both","billing_class":"facility"}]},{"description":"Clozaril","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2505059","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687054801","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"setting":"both","billing_class":"facility"}]},{"description":"Fioricet w/Codeine","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2505138","type":"CDM"},{"code":"637","type":"RC"},{"code":"51991007301","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"setting":"both","billing_class":"facility"}]},{"description":"Colcrys","drug_information":{"unit":"0.6","type":"UN"},"code_information":[{"code":"2505206","type":"CDM"},{"code":"637","type":"RC"},{"code":"67877058901","type":"NDC"}],"standard_charges":[{"gross_charge":40.44,"setting":"both","billing_class":"facility"}]},{"description":"Colestid","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2505225","type":"CDM"},{"code":"637","type":"RC"},{"code":"00115521116","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"setting":"both","billing_class":"facility"}]},{"description":"Santyl Oint 250 U/GM 30 GM","drug_information":{"unit":"30","type":"GM"},"code_information":[{"code":"2505245","type":"CDM"},{"code":"250","type":"RC"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":1616.89,"setting":"both","billing_class":"facility"}]},{"description":"Cordarone","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2505319","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739005110","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cortisporin Ophth","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2505365","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"gross_charge":726.54,"setting":"both","billing_class":"facility"}]},{"description":"Cortrosyn","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2505390","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"00548590000","type":"NDC"}],"standard_charges":[{"gross_charge":138.9,"setting":"both","billing_class":"facility"}]},{"description":"Septra 800mg/160mg","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2505400","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069036201","type":"NDC"}],"standard_charges":[{"gross_charge":37.17,"setting":"both","billing_class":"facility"}]},{"description":"Septra DS 800/160mg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2505440","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687061401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin B12","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2505521","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268085415","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN B-12","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2505522","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268085515","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cyclogyl 1% 2mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2505565","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":268.56,"setting":"both","billing_class":"facility"}]},{"description":"Cyclogyl 2%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2505566","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065039702","type":"NDC"}],"standard_charges":[{"gross_charge":219.06,"setting":"both","billing_class":"facility"}]},{"description":"Cytoxan","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2505589","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"00781323394","type":"NDC"}],"standard_charges":[{"gross_charge":594.54,"setting":"both","billing_class":"facility"}]},{"description":"Cytoxan","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2505592","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"70121124001","type":"NDC"}],"standard_charges":[{"gross_charge":1680.69,"setting":"both","billing_class":"facility"}]},{"description":"Flexeril","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2505600","type":"CDM"},{"code":"637","type":"RC"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"setting":"both","billing_class":"facility"}]},{"description":"Ara C","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2505725","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":38.04,"setting":"both","billing_class":"facility"}]},{"description":"Ara C","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2505727","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"63323012020","type":"NDC"}],"standard_charges":[{"gross_charge":125.4,"setting":"both","billing_class":"facility"}]},{"description":"Dalvance","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2505734","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0875","type":"HCPCS"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"gross_charge":5093.0,"setting":"both","billing_class":"facility"}]},{"description":"Pradaxa","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2505735","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597035556","type":"NDC"}],"standard_charges":[{"gross_charge":19.86,"setting":"both","billing_class":"facility"}]},{"description":"Pradaxa","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2505736","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597036082","type":"NDC"}],"standard_charges":[{"gross_charge":19.86,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505744","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513000204","type":"NDC"}],"standard_charges":[{"gross_charge":1120.36,"setting":"both","billing_class":"facility"}]},{"description":"DECITABINE","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2505745","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"25021021920","type":"NDC"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 25 mcg ESRD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505747","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513000201","type":"NDC"}],"standard_charges":[{"gross_charge":1120.36,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 40 mcg ESRD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505748","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513000304","type":"NDC"}],"standard_charges":[{"gross_charge":1702.8,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 10% in Water","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2505749","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338002303","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 10% in Water","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505750","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2505751","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":11203.65,"setting":"both","billing_class":"facility"}]},{"description":"Desferal","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2505753","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"00078046791","type":"NDC"}],"standard_charges":[{"gross_charge":192.92,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 100 mcg ESRD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505754","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513000504","type":"NDC"}],"standard_charges":[{"gross_charge":4108.00,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 200mcg ESRD","drug_information":{"unit":"1","type":"F2"},"code_information":[{"code":"2505755","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513000601","type":"NDC"}],"standard_charges":[{"gross_charge":7469.1,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505756","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513000601","type":"NDC"}],"standard_charges":[{"gross_charge":7469.1,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505758","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":18672.75,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 500mcg ESRD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505759","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":18672.75,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 300 mcg ESRD","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2505761","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":11203.65,"setting":"both","billing_class":"facility"}]},{"description":"Prolia","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505762","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":9048.95,"setting":"both","billing_class":"facility"}]},{"description":"XGeva","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"2505763","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":16645.0,"setting":"both","billing_class":"facility"}]},{"description":"ARANESP","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"2505765","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":7469.1,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505766","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513000404","type":"NDC"}],"standard_charges":[{"gross_charge":22240.74,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp 60mcg ESRD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505767","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513000404","type":"NDC"}],"standard_charges":[{"gross_charge":2464.81,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505768","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513000504","type":"NDC"}],"standard_charges":[{"gross_charge":4108.00,"setting":"both","billing_class":"facility"}]},{"description":"Cubicin","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"2505770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"68001046741","type":"NDC"}],"standard_charges":[{"gross_charge":1828.2,"setting":"both","billing_class":"facility"}]},{"description":"Aranesp","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505772","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513000304","type":"NDC"}],"standard_charges":[{"gross_charge":1702.8,"setting":"both","billing_class":"facility"}]},{"description":"Cubicin","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2505773","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"setting":"both","billing_class":"facility"}]},{"description":"DEXTENZA","drug_information":{"unit":"0.4","type":"UN"},"code_information":[{"code":"2505774","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1096","type":"HCPCS"},{"code":"70382020401","type":"NDC"}],"standard_charges":[{"gross_charge":3245.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in Water","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2505775","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in Water","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2505776","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 500mL Excel","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2505778","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"DEXTROSE 5% 250mL Excel","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2505780","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in LR","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505790","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 50%","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2505797","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990793619","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"DEXTROSE 50% 50mL Vial","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2505798","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409664802","type":"NDC"}],"standard_charges":[{"gross_charge":25.86,"setting":"both","billing_class":"facility"}]},{"description":"Potassium 40mEq in D5/0.45NS","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505799","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990790409","type":"NDC"}],"standard_charges":[{"gross_charge":42.42,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 0.2% Saline","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505800","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338007704","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 0.3% Saline","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505825","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990792509","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 0.45% Saline","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505840","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338008504","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 0.45% Saline","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2505845","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338008503","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% 0.9% Saline","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505850","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Potassium 20mEq in D5/0.45NS","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505865","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":35.4,"setting":"both","billing_class":"facility"}]},{"description":"Potassium 20mEq in D5/0.9NS","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505866","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":63.78,"setting":"both","billing_class":"facility"}]},{"description":"Potassium 40mEq in D5/0.9NS","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505867","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338080704","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in Water","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2505870","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001704","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in Water","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2505873","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001702","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 5% in Water","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2505874","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001703","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"DEXTROSE 70%-WATER IV SOLN","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2505875","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00264738750","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dtic-Dome IV","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2505890","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012820","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"}]},{"description":"DACARBAZINE","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2505891","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012820","type":"NDC"}],"standard_charges":[{"gross_charge":66.62,"setting":"both","billing_class":"facility"}]},{"description":"Ryanodex","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2505926","type":"CDM"},{"code":"252","type":"RC"},{"code":"42367054032","type":"NDC"}],"standard_charges":[{"gross_charge":16406.1,"setting":"both","billing_class":"facility"}]},{"description":"Dantrium","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2505930","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084030021","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"setting":"both","billing_class":"facility"}]},{"description":"Darzalex","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2505931","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":4265.96,"setting":"both","billing_class":"facility"}]},{"description":"Darzalex","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2505933","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":14706.5,"setting":"both","billing_class":"facility"}]},{"description":"Darzelex Faspro 1,800MG-30,000","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2505935","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":47573.42,"setting":"both","billing_class":"facility"}]},{"description":"Cerubidine","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2505951","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"00143955110","type":"NDC"}],"standard_charges":[{"gross_charge":804.84,"setting":"both","billing_class":"facility"}]},{"description":"Haldol Decanoate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2505955","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"63323047101","type":"NDC"}],"standard_charges":[{"gross_charge":130.62,"setting":"both","billing_class":"facility"}]},{"description":"EYE WASH SOLUTION","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"2505990","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536122497","type":"NDC"}],"standard_charges":[{"gross_charge":18.48,"setting":"both","billing_class":"facility"}]},{"description":"Depakote","drug_information":{"unit":"125","type":"UN"},"code_information":[{"code":"2505992","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001047200","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"setting":"both","billing_class":"facility"}]},{"description":"Desferal","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2505996","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"63323059930","type":"NDC"}],"standard_charges":[{"gross_charge":179.4,"setting":"both","billing_class":"facility"}]},{"description":"Suprane","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"2506021","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781617286","type":"NDC"}],"standard_charges":[{"gross_charge":1081.44,"setting":"both","billing_class":"facility"}]},{"description":"DDAVP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506030","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":118.10,"setting":"both","billing_class":"facility"}]},{"description":"DDAVP","drug_information":{"unit":"0.1","type":"UN"},"code_information":[{"code":"2506035","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001057400","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":193.02,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2506140","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"00054417925","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2506270","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"70954040310","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2506271","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614525","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506280","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614525","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"setting":"both","billing_class":"facility"}]},{"description":"Decadron","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506285","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":37.74,"setting":"both","billing_class":"facility"}]},{"description":"Maxidex 0.1% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2506290","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":302.4,"setting":"both","billing_class":"facility"}]},{"description":"Zinecard","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2506294","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72266010101","type":"NDC"}],"standard_charges":[{"gross_charge":2521.80,"setting":"both","billing_class":"facility"}]},{"description":"Precedex","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2506301","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288050503","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"setting":"both","billing_class":"facility"}]},{"description":"Precedex","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2506302","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143952610","type":"NDC"}],"standard_charges":[{"gross_charge":103.2,"setting":"both","billing_class":"facility"}]},{"description":"PRECEDEX","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2506303","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143952510","type":"NDC"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 25%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2506355","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"gross_charge":102.06,"setting":"both","billing_class":"facility"}]},{"description":"Dextrose 50%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2506370","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409751716","type":"NDC"}],"standard_charges":[{"gross_charge":97.8,"setting":"both","billing_class":"facility"}]},{"description":"DELFLEX WITH 2.5% DEXTROSE","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2506405","type":"CDM"},{"code":"250","type":"RC"},{"code":"49230020992","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"DELFLEX WITH 1.5% DEXTROSE","drug_information":{"unit":"2500","type":"ML"},"code_information":[{"code":"2506406","type":"CDM"},{"code":"250","type":"RC"},{"code":"49230020694","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Valium","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2506450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":95.72,"setting":"both","billing_class":"facility"}]},{"description":"Valium","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2506460","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079028620","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Valium","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2506470","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Valium","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2506500","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Nupercainal 28Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2506530","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"setting":"both","billing_class":"facility"}]},{"description":"Voltaren Gel 1% 100Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2506539","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Bentyl","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2506575","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"BentyL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2506576","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"58914008052","type":"NDC"}],"standard_charges":[{"gross_charge":504.36,"setting":"both","billing_class":"facility"}]},{"description":"Bentyl","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2506577","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904698861","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Bentyl","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506579","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054062263","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Diflucan","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2506695","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"facility"}]},{"description":"Lanoxin Pediatric","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506715","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515026210","type":"NDC"}],"standard_charges":[{"gross_charge":826.38,"setting":"both","billing_class":"facility"}]},{"description":"Lanoxin","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2506730","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"setting":"both","billing_class":"facility"}]},{"description":"Lanoxin Liquid","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506731","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054005746","type":"NDC"}],"standard_charges":[{"gross_charge":8.77,"setting":"both","billing_class":"facility"}]},{"description":"Lanoxin","drug_information":{"unit":"125","type":"UN"},"code_information":[{"code":"2506740","type":"CDM"},{"code":"637","type":"RC"},{"code":"00143124001","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"setting":"both","billing_class":"facility"}]},{"description":"Digibind","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2506755","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":22145.3,"setting":"both","billing_class":"facility"}]},{"description":"DILATING COMBO SOLN OPHTH","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2506801","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266822001","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"TROP/CYCLO/PHEN 0.5 ML SYINGE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2506802","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"71266821101","type":"NDC"}],"standard_charges":[{"gross_charge":58.38,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem CD","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2506815","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"60687019501","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem CD","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2506817","type":"CDM"},{"code":"637","type":"RC"},{"code":"24979002907","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem CD","drug_information":{"unit":"240","type":"UN"},"code_information":[{"code":"2506818","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687021701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem CD","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"2506819","type":"CDM"},{"code":"637","type":"RC"},{"code":"50742024990","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2506820","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"68682000610","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2506821","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00641601310","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2506828","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860030125","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"setting":"both","billing_class":"facility"}]},{"description":"Cardizem","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2506830","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"68682000710","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"setting":"both","billing_class":"facility"}]},{"description":"Rimso-50 50%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2506855","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"67457017750","type":"NDC"}],"standard_charges":[{"gross_charge":3631.32,"setting":"both","billing_class":"facility"}]},{"description":"Adacel","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2506906","type":"CDM"},{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040010","type":"NDC"}],"standard_charges":[{"gross_charge":563.4,"setting":"both","billing_class":"facility"}]},{"description":"Benadryl","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2506910","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121048900","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"setting":"both","billing_class":"facility"}]},{"description":"Benadryl Cream 28Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2506945","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":14.22,"setting":"both","billing_class":"facility"}]},{"description":"Benadryl","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2506946","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904723761","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Benadryl","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2506970","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904205661","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Benadryl","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2506990","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"setting":"both","billing_class":"facility"}]},{"description":"Lomotil 0.025mg/2.5mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2507010","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406123601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Depakote Delayed Release","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2507150","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084077601","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"setting":"both","billing_class":"facility"}]},{"description":"Depakote Sprinkles","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"2507151","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"setting":"both","billing_class":"facility"}]},{"description":"Depakote ER","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2507155","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084031001","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"setting":"both","billing_class":"facility"}]},{"description":"Depakote Delayed Release","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2507156","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832712401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Depakote ER","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2507160","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862059501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dobutamine/D5W Drip","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2507171","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"gross_charge":134.7,"setting":"both","billing_class":"facility"}]},{"description":"DOCEtaxel MDV","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"2507172","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"67457053208","type":"NDC"}],"standard_charges":[{"gross_charge":1815.0,"setting":"both","billing_class":"facility"}]},{"description":"Taxotere","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"2507178","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00409020120","type":"NDC"}],"standard_charges":[{"gross_charge":595.56,"setting":"both","billing_class":"facility"}]},{"description":"Colace","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2507180","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904718361","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"KISUNLA","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2507275","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0175","type":"HCPCS"},{"code":"00002940101","type":"NDC"}],"standard_charges":[{"gross_charge":3826.08,"setting":"both","billing_class":"facility"}]},{"description":"Aricept","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2507277","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904647761","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"DONEPEZIL HCL","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2507278","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687030301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Intropin/D5W","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2507295","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":85.2,"setting":"both","billing_class":"facility"}]},{"description":"Cosopt Plus","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2507297","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":50.76,"setting":"both","billing_class":"facility"}]},{"description":"Dopram","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507300","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601801","type":"NDC"}],"standard_charges":[{"gross_charge":294.3,"setting":"both","billing_class":"facility"}]},{"description":"Trusopt 2%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2507304","type":"CDM"},{"code":"637","type":"RC"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"gross_charge":128.58,"setting":"both","billing_class":"facility"}]},{"description":"Cardura","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2507305","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084083625","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"setting":"both","billing_class":"facility"}]},{"description":"Cardura","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2507306","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904552461","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"setting":"both","billing_class":"facility"}]},{"description":"Sinequan","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2507330","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"setting":"both","billing_class":"facility"}]},{"description":"Sinequan","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2507340","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079043820","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"setting":"both","billing_class":"facility"}]},{"description":"DoxiL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2507354","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006301","type":"NDC"}],"standard_charges":[{"gross_charge":1760.88,"setting":"both","billing_class":"facility"}]},{"description":"Adriamycin","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2507357","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"25021020725","type":"NDC"}],"standard_charges":[{"gross_charge":114.18,"setting":"both","billing_class":"facility"}]},{"description":"Vibramycin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2507380","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"gross_charge":181.2,"setting":"both","billing_class":"facility"}]},{"description":"Vibramycin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2507385","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687051365","type":"NDC"}],"standard_charges":[{"gross_charge":12.06,"setting":"both","billing_class":"facility"}]},{"description":"Dofetilide","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2507427","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205003960","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 125 MCG"}]},{"description":"Dofetilide","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2507428","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004060","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 250 MCG"}]},{"description":"Multaq","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2507429","type":"CDM"},{"code":"637","type":"RC"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"setting":"both","billing_class":"facility"}]},{"description":"Cymbalta","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2507431","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687072321","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cymbalta","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2507432","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001059504","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cymbalta","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2507433","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001059604","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Duovisc Viscoelastic System","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2507435","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183150","type":"NDC"}],"standard_charges":[{"gross_charge":1472.4,"setting":"both","billing_class":"facility"}]},{"description":"DUPIXENT SYRINGE","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2507440","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"00024591401","type":"NDC"}],"standard_charges":[{"gross_charge":9634.0,"setting":"both","billing_class":"facility"}]},{"description":"Imfinzi","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"2507441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310450012","type":"NDC"}],"standard_charges":[{"gross_charge":5052.55,"setting":"both","billing_class":"facility"}]},{"description":"Imfinzi","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2507443","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"gross_charge":21052.25,"setting":"both","billing_class":"facility"}]},{"description":"SOLIRIS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2507550","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":29353.5,"setting":"both","billing_class":"facility"}]},{"description":"Vyvgart","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2507551","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9332","type":"HCPCS"},{"code":"73475304105","type":"NDC"}],"standard_charges":[{"gross_charge":27856.71,"setting":"both","billing_class":"facility"}]},{"description":"Uplizna","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2507552","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1823","type":"HCPCS"},{"code":"75987015003","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Radicava","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2507553","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1301","type":"HCPCS"},{"code":"70510217102","type":"NDC"}],"standard_charges":[{"gross_charge":5538.6,"setting":"both","billing_class":"facility"}]},{"description":"Vyvgart Hytrulo 1,008MG-11,200","drug_information":{"unit":"5.6","type":"ML"},"code_information":[{"code":"2507555","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9334","type":"HCPCS"},{"code":"73475310203","type":"NDC"}],"standard_charges":[{"gross_charge":72398.07,"setting":"both","billing_class":"facility"}]},{"description":"TPN Lytes","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2507562","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409577901","type":"NDC"}],"standard_charges":[{"gross_charge":61.92,"setting":"both","billing_class":"facility"}]},{"description":"EMPLICITI","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2507563","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"00003229111","type":"NDC"}],"standard_charges":[{"gross_charge":11155.2,"setting":"both","billing_class":"facility"}]},{"description":"EMPLICITI","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2507564","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"00003452211","type":"NDC"}],"standard_charges":[{"gross_charge":14873.45,"setting":"both","billing_class":"facility"}]},{"description":"Emla 5Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2507567","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168035756","type":"NDC"}],"standard_charges":[{"gross_charge":40.78,"setting":"both","billing_class":"facility"}]},{"description":"JARDIANCE","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2507568","type":"CDM"},{"code":"637","type":"RC"},{"code":"00597015237","type":"NDC"}],"standard_charges":[{"gross_charge":122.22,"setting":"both","billing_class":"facility"}]},{"description":"JARDIANCE","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2507569","type":"CDM"},{"code":"637","type":"RC"},{"code":"00597015337","type":"NDC"}],"standard_charges":[{"gross_charge":122.22,"setting":"both","billing_class":"facility"}]},{"description":"TRUVADA 200-300MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2507572","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vasotec","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507581","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"gross_charge":31.86,"setting":"both","billing_class":"facility"}]},{"description":"Vasotec","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2507590","type":"CDM"},{"code":"637","type":"RC"},{"code":"43547054610","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vasotec","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2507593","type":"CDM"},{"code":"637","type":"RC"},{"code":"43547054710","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Padcev","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2507594","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"51144002001","type":"NDC"}],"standard_charges":[{"gross_charge":14045.0,"setting":"both","billing_class":"facility"}]},{"description":"Padcev","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2507595","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"51144003001","type":"NDC"}],"standard_charges":[{"gross_charge":21067.5,"setting":"both","billing_class":"facility"}]},{"description":"ETESEVIMAB (EUA)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2507599","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00002795001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2507665","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507666","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043689","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2507667","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":19.28,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2507668","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043792","type":"NDC"}],"standard_charges":[{"gross_charge":48.82,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"2507669","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001045842","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2507671","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046441","type":"NDC"}],"standard_charges":[{"gross_charge":230.4,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507672","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043894","type":"NDC"}],"standard_charges":[{"gross_charge":83.76,"setting":"both","billing_class":"facility"}]},{"description":"Ephedrine","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2507739","type":"CDM"},{"code":"637","type":"RC"},{"code":"71266902505","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"setting":"both","billing_class":"facility"}]},{"description":"Ephedrine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507740","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781326995","type":"NDC"}],"standard_charges":[{"gross_charge":240.18,"setting":"both","billing_class":"facility"}]},{"description":"EpiPen","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2507765","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502010202","type":"NDC"}],"standard_charges":[{"gross_charge":900.0,"setting":"both","billing_class":"facility"}]},{"description":"Epinephrine HCl","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"2507772","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":687.6,"setting":"both","billing_class":"facility"}]},{"description":"EpiPen Jr.","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2507775","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"00115169549","type":"NDC"}],"standard_charges":[{"gross_charge":1482.06,"setting":"both","billing_class":"facility"}]},{"description":"Adrenalin Topical 1:1000","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2507820","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":1386.78,"setting":"both","billing_class":"facility"}]},{"description":"Epinephrine 1:1000 PF","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507823","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":49.45,"setting":"both","billing_class":"facility"}]},{"description":"Vaponefrin 2.25%","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2507870","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPHrine","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2507880","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"setting":"both","billing_class":"facility"}]},{"description":"Procrit","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507882","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"gross_charge":2836.86,"setting":"both","billing_class":"facility"}]},{"description":"Procrit","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507904","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":5157.92,"setting":"both","billing_class":"facility"}]},{"description":"VYEPTI","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507905","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":9440.75,"setting":"both","billing_class":"facility"}]},{"description":"Procrit","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507906","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"gross_charge":641.4,"setting":"both","billing_class":"facility"}]},{"description":"RETACRIT","drug_information":{"unit":"0.05","type":"ML"},"code_information":[{"code":"2507914","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"gross_charge":62.59,"setting":"both","billing_class":"facility"}]},{"description":"RETACRIT","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2507915","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":3126.97,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin D2","drug_information":{"unit":"50000","type":"UN"},"code_information":[{"code":"2507921","type":"CDM"},{"code":"637","type":"RC"},{"code":"69452015120","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"INVanz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2507931","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"72266015905","type":"NDC"}],"standard_charges":[{"gross_charge":122.23,"setting":"both","billing_class":"facility"}]},{"description":"Ery-Tab","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2508070","type":"CDM"},{"code":"637","type":"RC"},{"code":"52536018003","type":"NDC"}],"standard_charges":[{"gross_charge":50.34,"setting":"both","billing_class":"facility"}]},{"description":"Halaven","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2508100","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":7050.0,"setting":"both","billing_class":"facility"}]},{"description":"Ilotycin 0.5% 5MG/1GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508101","type":"CDM"},{"code":"637","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":49.01,"setting":"both","billing_class":"facility"}]},{"description":"Lexapro","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2508115","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904642661","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ESCITALOPRAM OUTPT PHA STOCK","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2508117","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729017001","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"setting":"both","billing_class":"facility"}]},{"description":"Brevibloc","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2508160","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":52.8,"setting":"both","billing_class":"facility"}]},{"description":"Esmolol HCl/SWFI","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2508161","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567081110","type":"NDC"}],"standard_charges":[{"gross_charge":560.1,"setting":"both","billing_class":"facility"}]},{"description":"ESMOLOL 2,500 MG/250 ML-NACL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2508162","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"70121171607","type":"NDC"}],"standard_charges":[{"gross_charge":1080.0,"setting":"both","billing_class":"facility"}]},{"description":"Premarin 30Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508185","type":"CDM"},{"code":"250","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":2292.12,"setting":"both","billing_class":"facility"}]},{"description":"Estrace","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508198","type":"CDM"},{"code":"637","type":"RC"},{"code":"42806008801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Premarin","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2508260","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1410","type":"HCPCS"},{"code":"00046074905","type":"NDC"}],"standard_charges":[{"gross_charge":2024.28,"setting":"both","billing_class":"facility"}]},{"description":"ETHAMBUTOL HCL","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2508317","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084028001","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"setting":"both","billing_class":"facility"}]},{"description":"ETHAMBUTOL HCL","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2508318","type":"CDM"},{"code":"637","type":"RC"},{"code":"68180028001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vespid","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2508390","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":68.22,"setting":"both","billing_class":"facility"}]},{"description":"ETOMIDATE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2508398","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"setting":"both","billing_class":"facility"}]},{"description":"Etomidate","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2508399","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022220","type":"NDC"}],"standard_charges":[{"gross_charge":66.6,"setting":"both","billing_class":"facility"}]},{"description":"Zetia","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2508404","type":"CDM"},{"code":"637","type":"RC"},{"code":"59651005290","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Pepcid","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2508410","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"setting":"both","billing_class":"facility"}]},{"description":"Pepcid","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2508420","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687059501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Pepcid","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2508430","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268030415","type":"NDC"}],"standard_charges":[{"gross_charge":19.62,"setting":"both","billing_class":"facility"}]},{"description":"Rebyota","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"2508431","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1440","type":"HCPCS"},{"code":"55566980002","type":"NDC"}],"standard_charges":[{"gross_charge":41107.5,"setting":"both","billing_class":"facility"}]},{"description":"Triglide","drug_information":{"unit":"54","type":"UN"},"code_information":[{"code":"2508433","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268031215","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"setting":"both","billing_class":"facility"}]},{"description":"Triglide","drug_information":{"unit":"160","type":"UN"},"code_information":[{"code":"2508438","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268031315","type":"NDC"}],"standard_charges":[{"gross_charge":30.78,"setting":"both","billing_class":"facility"}]},{"description":"Plendil","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2508441","type":"CDM"},{"code":"637","type":"RC"},{"code":"57237010901","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"setting":"both","billing_class":"facility"}]},{"description":"Duragesic","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2508445","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406915076","type":"NDC"}],"standard_charges":[{"gross_charge":158.16,"setting":"both","billing_class":"facility"}]},{"description":"Duragesic","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2508446","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406912576","type":"NDC"}],"standard_charges":[{"gross_charge":86.52,"setting":"both","billing_class":"facility"}]},{"description":"Duragesic","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2508447","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406917576","type":"NDC"}],"standard_charges":[{"gross_charge":241.26,"setting":"both","billing_class":"facility"}]},{"description":"Duragesic","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2508448","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406910076","type":"NDC"}],"standard_charges":[{"gross_charge":136.00,"setting":"both","billing_class":"facility"}]},{"description":"Duragesic","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"2508453","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406911276","type":"NDC"}],"standard_charges":[{"gross_charge":121.8,"setting":"both","billing_class":"facility"}]},{"description":"Bupiv/Fent Cit/NaCl 0.125% 2mcg","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2508455","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092110436","type":"NDC"}],"standard_charges":[{"gross_charge":160.08,"setting":"both","billing_class":"facility"}]},{"description":"Fentanyl Drip","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2508457","type":"CDM"},{"code":"250","type":"RC"},{"code":"70004020240","type":"NDC"}],"standard_charges":[{"gross_charge":198.66,"setting":"both","billing_class":"facility"}]},{"description":"Sublimaze","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2508460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"setting":"both","billing_class":"facility"}]},{"description":"Sublimaze","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2508477","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"setting":"both","billing_class":"facility"}]},{"description":"Sublimaze","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2508478","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"facility"}]},{"description":"Injectafer","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2508497","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":6818.1,"setting":"both","billing_class":"facility"}]},{"description":"Ferrlecit","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2508501","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":176.68,"setting":"both","billing_class":"facility"}]},{"description":"Ferrous Sulfate","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2508515","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"setting":"both","billing_class":"facility"}]},{"description":"Ferrous Sulfate","drug_information":{"unit":"325","type":"UN"},"code_information":[{"code":"2508560","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904759161","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Feraheme","drug_information":{"unit":"17","type":"ML"},"code_information":[{"code":"2508571","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":2011.74,"setting":"both","billing_class":"facility"}]},{"description":"Monsel's","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"2508578","type":"CDM"},{"code":"250","type":"RC"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Astringyn 8Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508579","type":"CDM"},{"code":"250","type":"RC"},{"code":"59365606500","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"setting":"both","billing_class":"facility"}]},{"description":"ZARXIO","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2508580","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":1508.98,"setting":"both","billing_class":"facility"}]},{"description":"ZARXIO","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2508581","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":2269.41,"setting":"both","billing_class":"facility"}]},{"description":"Phenergan","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2508582","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"gross_charge":106.26,"setting":"both","billing_class":"facility"}]},{"description":"NIVESTYM","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2508583","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029110","type":"NDC"}],"standard_charges":[{"gross_charge":1314.0,"setting":"both","billing_class":"facility"}]},{"description":"Neupogen","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2508584","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513053010","type":"NDC"}],"standard_charges":[{"gross_charge":1670.98,"setting":"both","billing_class":"facility"}]},{"description":"Fiber-Con","drug_information":{"unit":"625","type":"UN"},"code_information":[{"code":"2508585","type":"CDM"},{"code":"637","type":"RC"},{"code":"00536430608","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Fioricet","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508586","type":"CDM"},{"code":"637","type":"RC"},{"code":"00527169501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"NIVESTYM","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2508587","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029201","type":"NDC"}],"standard_charges":[{"gross_charge":1748.23,"setting":"both","billing_class":"facility"}]},{"description":"Proscar","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2508588","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687042865","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"setting":"both","billing_class":"facility"}]},{"description":"Tambocor","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2508611","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054001020","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"setting":"both","billing_class":"facility"}]},{"description":"Flomax","drug_information":{"unit":"0.4","type":"UN"},"code_information":[{"code":"2508632","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"gross_charge":25.26,"setting":"both","billing_class":"facility"}]},{"description":"Flonase 16Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2508635","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":54.18,"setting":"both","billing_class":"facility"}]},{"description":"Floxuridine","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2508663","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9200","type":"HCPCS"},{"code":"00143927001","type":"NDC"}],"standard_charges":[{"gross_charge":714.0,"setting":"both","billing_class":"facility"}]},{"description":"Diflucan","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2508670","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"setting":"both","billing_class":"facility"}]},{"description":"Diflucan","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2508673","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001025317","type":"NDC"}],"standard_charges":[{"gross_charge":84.06,"setting":"both","billing_class":"facility"}]},{"description":"Diflucan","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2508677","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904650061","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"setting":"both","billing_class":"facility"}]},{"description":"Florinef","drug_information":{"unit":"0.1","type":"UN"},"code_information":[{"code":"2508678","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"setting":"both","billing_class":"facility"}]},{"description":"Romazicon","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2508679","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000014810","type":"NDC"}],"standard_charges":[{"gross_charge":42.54,"setting":"both","billing_class":"facility"}]},{"description":"fluorouraciL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2508991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":175.8,"setting":"both","billing_class":"facility"}]},{"description":"fluorouraciL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2508995","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":20.52,"setting":"both","billing_class":"facility"}]},{"description":"fluorouraciL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2508997","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":87.9,"setting":"both","billing_class":"facility"}]},{"description":"Fluor-I-Strip","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509005","type":"CDM"},{"code":"250","type":"RC"},{"code":"17238090030","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Prolixin","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509040","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023012901","type":"NDC"}],"standard_charges":[{"gross_charge":936.0,"setting":"both","billing_class":"facility"}]},{"description":"Prolixin Deconate","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2509080","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150026705","type":"NDC"}],"standard_charges":[{"gross_charge":305.58,"setting":"both","billing_class":"facility"}]},{"description":"Prolixin","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509090","type":"CDM"},{"code":"637","type":"RC"},{"code":"69238168001","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"setting":"both","billing_class":"facility"}]},{"description":"Breo Ellipta 100-25mcg INH","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509099","type":"CDM"},{"code":"252","type":"RC"},{"code":"00173085914","type":"NDC"}],"standard_charges":[{"gross_charge":871.68,"setting":"both","billing_class":"facility"}]},{"description":"FML 0.1% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509190","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":398.64,"setting":"both","billing_class":"facility"}]},{"description":"Flovent HFA 220mcg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509191","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008096","type":"NDC"}],"standard_charges":[{"gross_charge":1364.28,"setting":"both","billing_class":"facility"}]},{"description":"Flovent HFA 110mcg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509192","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007996","type":"NDC"}],"standard_charges":[{"gross_charge":878.34,"setting":"both","billing_class":"facility"}]},{"description":"Flovent HFA 44mcg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509194","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007896","type":"NDC"}],"standard_charges":[{"gross_charge":656.1,"setting":"both","billing_class":"facility"}]},{"description":"Luvox","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2509198","type":"CDM"},{"code":"637","type":"RC"},{"code":"62559015901","type":"NDC"}],"standard_charges":[{"gross_charge":15.42,"setting":"both","billing_class":"facility"}]},{"description":"Folic Acid","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509200","type":"CDM"},{"code":"637","type":"RC"},{"code":"53746036101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Monurol","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2509203","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097057967","type":"NDC"}],"standard_charges":[{"gross_charge":316.74,"setting":"both","billing_class":"facility"}]},{"description":"Cerebyx","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509204","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040310","type":"NDC"}],"standard_charges":[{"gross_charge":135.0,"setting":"both","billing_class":"facility"}]},{"description":"Arixtra","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2509206","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"70710151609","type":"NDC"}],"standard_charges":[{"gross_charge":814.8,"setting":"both","billing_class":"facility"}]},{"description":"Arixtra","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2509207","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"00781347612","type":"NDC"}],"standard_charges":[{"gross_charge":712.98,"setting":"both","billing_class":"facility"}]},{"description":"Preparation H","drug_information":{"unit":"57","type":"GM"},"code_information":[{"code":"2509209","type":"CDM"},{"code":"637","type":"RC"},{"code":"46122067746","type":"NDC"}],"standard_charges":[{"gross_charge":70.74,"setting":"both","billing_class":"facility"}]},{"description":"Folvite","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509210","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":210.0,"setting":"both","billing_class":"facility"}]},{"description":"Arixtra","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2509211","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111067810","type":"NDC"}],"standard_charges":[{"gross_charge":327.9,"setting":"both","billing_class":"facility"}]},{"description":"Fosamax","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2509213","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980034001","type":"NDC"}],"standard_charges":[{"gross_charge":17.52,"setting":"both","billing_class":"facility"}]},{"description":"Cerebyx","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2509214","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":28.8,"setting":"both","billing_class":"facility"}]},{"description":"Monopril","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2509215","type":"CDM"},{"code":"637","type":"RC"},{"code":"43547038609","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"setting":"both","billing_class":"facility"}]},{"description":"Antizol","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2509216","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":2622.90,"setting":"both","billing_class":"facility"}]},{"description":"Emend","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509219","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"72205005401","type":"NDC"}],"standard_charges":[{"gross_charge":125.04,"setting":"both","billing_class":"facility"}]},{"description":"Lasix","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2509250","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315011601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Prozac","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2509256","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lasix","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2509260","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315011701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Faslodex","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2509261","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026223","type":"NDC"}],"standard_charges":[{"gross_charge":256.77,"setting":"both","billing_class":"facility"}]},{"description":"Lasix","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2509268","type":"CDM"},{"code":"637","type":"RC"},{"code":"43547040310","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lasix","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2509270","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"setting":"both","billing_class":"facility"}]},{"description":"Neurontin 300mg/6mL UDC","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"2509292","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":43.26,"setting":"both","billing_class":"facility"}]},{"description":"Neurontin","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2509293","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687060201","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"setting":"both","billing_class":"facility"}]},{"description":"Neurontin","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2509295","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":8.28,"setting":"both","billing_class":"facility"}]},{"description":"Neurontin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2509296","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Neurontin","drug_information":{"unit":"800","type":"UN"},"code_information":[{"code":"2509298","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687051801","type":"NDC"}],"standard_charges":[{"gross_charge":17.46,"setting":"both","billing_class":"facility"}]},{"description":"GANCICLOVIR SODIUM","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2509300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"00143929910","type":"NDC"}],"standard_charges":[{"gross_charge":186.13,"setting":"both","billing_class":"facility"}]},{"description":"Lopid","drug_information":{"unit":"600","type":"UN"},"code_information":[{"code":"2509348","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687022401","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin 15Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509350","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004635","type":"NDC"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"}]},{"description":"Gemzar","drug_information":{"unit":"5.26","type":"ML"},"code_information":[{"code":"2509355","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":55.98,"setting":"both","billing_class":"facility"}]},{"description":"Gemzar","drug_information":{"unit":"26.3","type":"ML"},"code_information":[{"code":"2509358","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":144.24,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin 3.5Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509370","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"gross_charge":159.12,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2509377","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2509379","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040125","type":"NDC"}],"standard_charges":[{"gross_charge":37.02,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2509380","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00409120713","type":"NDC"}],"standard_charges":[{"gross_charge":27.84,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin 0.3% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509400","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"setting":"both","billing_class":"facility"}]},{"description":"Gentamicin 80mg/100mL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2509435","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348","type":"NDC"}],"standard_charges":[{"gross_charge":23.94,"setting":"both","billing_class":"facility"}]},{"description":"Amaryl","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2509438","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"setting":"both","billing_class":"facility"}]},{"description":"GLIMEPIRIDE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509439","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084078825","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"setting":"both","billing_class":"facility"}]},{"description":"Razadyne","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2509442","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084072921","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"setting":"both","billing_class":"facility"}]},{"description":"Glucotrol","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509450","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505014100","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"glipiZIDE","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2509451","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"60505014200","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glucotrol XL","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509452","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084011101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glucotrol XL","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2509453","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687048021","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"setting":"both","billing_class":"facility"}]},{"description":"Micronase","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2509458","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093834301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glucagon","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1611","type":"HCPCS"},{"code":"00597026010","type":"NDC"}],"standard_charges":[{"gross_charge":1403.88,"setting":"both","billing_class":"facility"}]},{"description":"Glucose 4Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509475","type":"CDM"},{"code":"637","type":"RC"},{"code":"56151161211","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"setting":"both","billing_class":"facility"}]},{"description":"Glutose 40% GEL 31Gm","drug_information":{"unit":"31","type":"UN"},"code_information":[{"code":"2509477","type":"CDM"},{"code":"637","type":"RC"},{"code":"00187074633","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"setting":"both","billing_class":"facility"}]},{"description":"Micronase","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509500","type":"CDM"},{"code":"637","type":"RC"},{"code":"72241004005","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glycopyrrolate","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2509509","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"71288041404","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"setting":"both","billing_class":"facility"}]},{"description":"Glycerin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509540","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122022171","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Robinul","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509571","type":"CDM"},{"code":"637","type":"RC"},{"code":"16571074309","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glycopyrrolate","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2509573","type":"CDM"},{"code":"637","type":"RC"},{"code":"71266901505","type":"NDC"}],"standard_charges":[{"gross_charge":112.8,"setting":"both","billing_class":"facility"}]},{"description":"Glycerin-Pediatric","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509580","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980040912","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SIMPONI ARIA","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2509620","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":9646.1,"setting":"both","billing_class":"facility"}]},{"description":"Go-Lytly","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"2509625","type":"CDM"},{"code":"252","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":149.28,"setting":"both","billing_class":"facility"}]},{"description":"Zoladex","drug_information":{"unit":"3.6","type":"UN"},"code_information":[{"code":"2509645","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"70720095036","type":"NDC"}],"standard_charges":[{"gross_charge":5257.0,"setting":"both","billing_class":"facility"}]},{"description":"Kytril","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2509653","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"00143974410","type":"NDC"}],"standard_charges":[{"gross_charge":17.41,"setting":"both","billing_class":"facility"}]},{"description":"Robitussin","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509670","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"setting":"both","billing_class":"facility"}]},{"description":"Robitussin DM 200 mg-20 mg","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509671","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"setting":"both","billing_class":"facility"}]},{"description":"Robitussin AC 20 mg-200 mg","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2509672","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"setting":"both","billing_class":"facility"}]},{"description":"Mucinex","drug_information":{"unit":"600","type":"UN"},"code_information":[{"code":"2509695","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084057201","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"setting":"both","billing_class":"facility"}]},{"description":"TREMFYA","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2509700","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1628","type":"HCPCS"},{"code":"57894065002","type":"NDC"}],"standard_charges":[{"gross_charge":65548.98,"setting":"both","billing_class":"facility"}]},{"description":"Mucinex DM 600 mg-30 mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509714","type":"CDM"},{"code":"637","type":"RC"},{"code":"63824005634","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ultravate 0.05% 15Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509745","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802013135","type":"NDC"}],"standard_charges":[{"gross_charge":171.48,"setting":"both","billing_class":"facility"}]},{"description":"Haldol","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2509751","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Haldol","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509780","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079073420","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Haldol","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2509800","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121058105","type":"NDC"}],"standard_charges":[{"gross_charge":25.14,"setting":"both","billing_class":"facility"}]},{"description":"Haldol Decanoate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2509830","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"70069038101","type":"NDC"}],"standard_charges":[{"gross_charge":160.08,"setting":"both","billing_class":"facility"}]},{"description":"Haldol","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2509840","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"setting":"both","billing_class":"facility"}]},{"description":"Haldol","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2509850","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687016101","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"setting":"both","billing_class":"facility"}]},{"description":"Prinvil","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2509868","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687032501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Hytone 1% 28.35Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509920","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"setting":"both","billing_class":"facility"}]},{"description":"Hydrocortisone Base","drug_information":{"unit":"25","type":"GM"},"code_information":[{"code":"2509934","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779000904","type":"NDC"}],"standard_charges":[{"gross_charge":385.08,"setting":"both","billing_class":"facility"}]},{"description":"Hydrocortisone1% 28Gm Ointment","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2509990","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"setting":"both","billing_class":"facility"}]},{"description":"Hytone 2.5% 30Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510008","type":"CDM"},{"code":"250","type":"RC"},{"code":"00472033730","type":"NDC"}],"standard_charges":[{"gross_charge":35.4,"setting":"both","billing_class":"facility"}]},{"description":"Hydromorphone PCA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2510037","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"69374098330","type":"NDC"}],"standard_charges":[{"gross_charge":161.82,"setting":"both","billing_class":"facility"}]},{"description":"Cyanokit","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2510041","type":"CDM"},{"code":"250","type":"RC"},{"code":"50633031011","type":"NDC"}],"standard_charges":[{"gross_charge":5489.0,"setting":"both","billing_class":"facility"}]},{"description":"Anusol HC 2.5% 30Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510063","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":233.04,"setting":"both","billing_class":"facility"}]},{"description":"Anusol HC","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2510065","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713050324","type":"NDC"}],"standard_charges":[{"gross_charge":129.06,"setting":"both","billing_class":"facility"}]},{"description":"Heparin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510080","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272101","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"setting":"both","billing_class":"facility"}]},{"description":"Heparin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510085","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Heparin","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2510091","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":20.22,"setting":"both","billing_class":"facility"}]},{"description":"Heparin Flush","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2510105","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Heparin Lock Flush","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2510106","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306414","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Heparin/D5W","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2510125","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264957710","type":"NDC"}],"standard_charges":[{"gross_charge":81.03,"setting":"both","billing_class":"facility"}]},{"description":"Vaqta Adult","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510131","type":"CDM"},{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"00006409602","type":"NDC"}],"standard_charges":[{"gross_charge":966.84,"setting":"both","billing_class":"facility"}]},{"description":"ENGERIX-B ADULT","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510140","type":"CDM"},{"code":"636","type":"RC"},{"code":"90747","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":824.88,"setting":"both","billing_class":"facility"}]},{"description":"Recombivax Pediatric Hd","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2510142","type":"CDM"},{"code":"636","type":"RC"},{"code":"90744","type":"HCPCS"},{"code":"00006409302","type":"NDC"}],"standard_charges":[{"gross_charge":318.6,"setting":"both","billing_class":"facility"}]},{"description":"Nabi-Hb","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2510178","type":"CDM"},{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"69800420301","type":"NDC"}],"standard_charges":[{"gross_charge":8280.03,"setting":"both","billing_class":"facility"}]},{"description":"Heparin","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2510212","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054036","type":"NDC"}],"standard_charges":[{"gross_charge":42.78,"setting":"both","billing_class":"facility"}]},{"description":"Hespan 6%/NS Infusion Bag","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2510230","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409724803","type":"NDC"}],"standard_charges":[{"gross_charge":137.1,"setting":"both","billing_class":"facility"}]},{"description":"Cysview","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2510241","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9589","type":"HCPCS"},{"code":"10511300102","type":"NDC"}],"standard_charges":[{"gross_charge":6535.0,"setting":"both","billing_class":"facility"}]},{"description":"Hurricane One 20% Spray UD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510372","type":"CDM"},{"code":"252","type":"RC"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"setting":"both","billing_class":"facility"}]},{"description":"Hylenex 150unit/mL SDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510396","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657011704","type":"NDC"}],"standard_charges":[{"gross_charge":310.02,"setting":"both","billing_class":"facility"}]},{"description":"PROVISC 0.55ML SYR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2510400","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"08065183055","type":"NDC"}],"standard_charges":[{"gross_charge":998.58,"setting":"both","billing_class":"facility"}]},{"description":"Durolane","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2510401","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7318","type":"HCPCS"},{"code":"89130202001","type":"NDC"}],"standard_charges":[{"gross_charge":5575.0,"setting":"both","billing_class":"facility"}]},{"description":"Gelsyn-3 16.8mg/2mL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2510402","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7328","type":"HCPCS"},{"code":"89130311101","type":"NDC"}],"standard_charges":[{"gross_charge":2134.0,"setting":"both","billing_class":"facility"}]},{"description":"EUFLEXXA 20MG/2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2510403","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7323","type":"HCPCS"},{"code":"55566410001","type":"NDC"}],"standard_charges":[{"gross_charge":1983.46,"setting":"both","billing_class":"facility"}]},{"description":"Hydrodiuril","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2510415","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"hydroCHLOROthiazide","drug_information":{"unit":"12.5","type":"UN"},"code_information":[{"code":"2510416","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729018217","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Solu-CORTEF","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2510450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"00009082501","type":"NDC"}],"standard_charges":[{"gross_charge":95.16,"setting":"both","billing_class":"facility"}]},{"description":"Cortisporin Otic Sol 10mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510460","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"gross_charge":288.12,"setting":"both","billing_class":"facility"}]},{"description":"Hydrea","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2510465","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084028401","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"setting":"both","billing_class":"facility"}]},{"description":"Apresoline","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2510480","type":"CDM"},{"code":"637","type":"RC"},{"code":"50111039801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Apresoline","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2510600","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00517090125","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"}]},{"description":"HYDRALAZINE HCL","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2510601","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904644261","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Solu-Cortef","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2510620","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"00009001305","type":"NDC"}],"standard_charges":[{"gross_charge":225.54,"setting":"both","billing_class":"facility"}]},{"description":"Vistaril","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2510640","type":"CDM"},{"code":"637","type":"RC"},{"code":"00185067401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dilaudid","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2510690","type":"CDM"},{"code":"637","type":"RC"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dilaudid","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2510699","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":230.04,"setting":"both","billing_class":"facility"}]},{"description":"Norco 5/325","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510727","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Norco 7.5/325","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2510728","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406012462","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"setting":"both","billing_class":"facility"}]},{"description":"Lortab 7.5-325 mg/15mL UDC","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2510732","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"setting":"both","billing_class":"facility"}]},{"description":"Vistaril","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2510769","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517560225","type":"NDC"}],"standard_charges":[{"gross_charge":255.12,"setting":"both","billing_class":"facility"}]},{"description":"Cortef","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2510925","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687058201","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"Apresoline","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2510960","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904644161","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Atarax","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2511080","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687066401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Atarax","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2511090","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093506101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Plaquenil","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2511115","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904704606","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"setting":"both","billing_class":"facility"}]},{"description":"Levsin","drug_information":{"unit":"0.125","type":"UN"},"code_information":[{"code":"2511141","type":"CDM"},{"code":"637","type":"RC"},{"code":"42192033901","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"setting":"both","billing_class":"facility"}]},{"description":"Oscimin SR","drug_information":{"unit":"0.375","type":"UN"},"code_information":[{"code":"2511142","type":"CDM"},{"code":"637","type":"RC"},{"code":"47781001401","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"setting":"both","billing_class":"facility"}]},{"description":"Hytrin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511144","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746038306","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"setting":"both","billing_class":"facility"}]},{"description":"Hytrin","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2511145","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746038406","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"setting":"both","billing_class":"facility"}]},{"description":"Stuart Natal 1+1","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511173","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904531360","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Motrin","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2511185","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904791461","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Motrin","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2511190","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687044601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Motrin","drug_information":{"unit":"600","type":"UN"},"code_information":[{"code":"2511196","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687045701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Motrin 100mg/5mL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2511199","type":"CDM"},{"code":"637","type":"RC"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"setting":"both","billing_class":"facility"}]},{"description":"MYXREDLIN 100 UNIT/100 ML BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511200","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"gross_charge":210.0,"setting":"both","billing_class":"facility"}]},{"description":"Praxbind","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511221","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"00597019705","type":"NDC"}],"standard_charges":[{"gross_charge":12692.25,"setting":"both","billing_class":"facility"}]},{"description":"Idarubicin Hydrochloride","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2511222","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"00143921701","type":"NDC"}],"standard_charges":[{"gross_charge":463.5,"setting":"both","billing_class":"facility"}]},{"description":"IFOSFAMIDE","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2511224","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":527.82,"setting":"both","billing_class":"facility"}]},{"description":"Ifex","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511225","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092501","type":"NDC"}],"standard_charges":[{"gross_charge":194.4,"setting":"both","billing_class":"facility"}]},{"description":"Privigen","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511226","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":3018.68,"setting":"both","billing_class":"facility"}]},{"description":"Privigen","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511227","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"gross_charge":9414.0,"setting":"both","billing_class":"facility"}]},{"description":"Privigen","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2511228","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"gross_charge":11416.0,"setting":"both","billing_class":"facility"}]},{"description":"Privigen","drug_information":{"unit":"400","type":"ML"},"code_information":[{"code":"2511229","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":22832.0,"setting":"both","billing_class":"facility"}]},{"description":"IMDEVIMAB (REGN10987) (EUA)","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"2511230","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"IMDEVIMAB (REGN10987) (EUA)","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2511231","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"FLEBOGAMMA DIF 5% 10G VIAL","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2511234","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1572","type":"HCPCS"},{"code":"61953000404","type":"NDC"}],"standard_charges":[{"gross_charge":5294.0,"setting":"both","billing_class":"facility"}]},{"description":"Gamunex-C","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511237","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":5803.0,"setting":"both","billing_class":"facility"}]},{"description":"Gamunex-C","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511238","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":3191.65,"setting":"both","billing_class":"facility"}]},{"description":"Gamunex-C","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2511239","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":11606.0,"setting":"both","billing_class":"facility"}]},{"description":"Gammagard","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511242","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":3088.08,"setting":"both","billing_class":"facility"}]},{"description":"Gammagard","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511246","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":5614.7,"setting":"both","billing_class":"facility"}]},{"description":"Gammagard","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"2511247","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":16844.1,"setting":"both","billing_class":"facility"}]},{"description":"Gammagard","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2511248","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":11229.4,"setting":"both","billing_class":"facility"}]},{"description":"Gamunex-C","drug_information":{"unit":"400","type":"ML"},"code_information":[{"code":"2511251","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":23212.0,"setting":"both","billing_class":"facility"}]},{"description":"Lozol","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2511255","type":"CDM"},{"code":"637","type":"RC"},{"code":"62559051101","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"setting":"both","billing_class":"facility"}]},{"description":"Tofranil","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2511270","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315013401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Imitrex","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2511295","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"setting":"both","billing_class":"facility"}]},{"description":"IC Green","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2511351","type":"CDM"},{"code":"252","type":"RC"},{"code":"C9776","type":"HCPCS"},{"code":"70100042402","type":"NDC"}],"standard_charges":[{"gross_charge":881.76,"setting":"both","billing_class":"facility"}]},{"description":"Indocin","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2511370","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Indocin","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2511385","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268043115","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"INDOCIN suppository","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2511386","type":"CDM"},{"code":"637","type":"RC"},{"code":"69344010233","type":"NDC"}],"standard_charges":[{"gross_charge":1203.80,"setting":"both","billing_class":"facility"}]},{"description":"Indocin SR","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2511415","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084041121","type":"NDC"}],"standard_charges":[{"gross_charge":18.48,"setting":"both","billing_class":"facility"}]},{"description":"Inflectra","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2511431","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"00069080901","type":"NDC"}],"standard_charges":[{"gross_charge":3911.66,"setting":"both","billing_class":"facility"}]},{"description":"Remicade","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2511433","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":5634.75,"setting":"both","billing_class":"facility"}]},{"description":"Renflexis","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2511435","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":2470.32,"setting":"both","billing_class":"facility"}]},{"description":"Fluzone Trivalent","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2511436","type":"CDM"},{"code":"636","type":"RC"},{"code":"90686","type":"HCPCS"},{"code":"49281042488","type":"NDC"}],"standard_charges":[{"gross_charge":248.15,"setting":"both","billing_class":"facility"}]},{"description":"Boniva","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511451","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"25021082761","type":"NDC"}],"standard_charges":[{"gross_charge":1375.0,"setting":"both","billing_class":"facility"}]},{"description":"Humulin R","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511463","type":"CDM"},{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":267.66,"setting":"both","billing_class":"facility"}]},{"description":"Humalog Kwikpen","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511464","type":"CDM"},{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002879959","type":"NDC"}],"standard_charges":[{"gross_charge":176.82,"setting":"both","billing_class":"facility"}]},{"description":"Lantus Solostar","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511465","type":"CDM"},{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00088221905","type":"NDC"}],"standard_charges":[{"gross_charge":107.1,"setting":"both","billing_class":"facility"}]},{"description":"Humulin 70/30 Kwikpen","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511466","type":"CDM"},{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002880359","type":"NDC"}],"standard_charges":[{"gross_charge":171.28,"setting":"both","billing_class":"facility"}]},{"description":"Humulin R U-500 Kwikpen","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511472","type":"CDM"},{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002882427","type":"NDC"}],"standard_charges":[{"gross_charge":1579.05,"setting":"both","billing_class":"facility"}]},{"description":"Intron A","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2511589","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9214","type":"HCPCS"},{"code":"00085435001","type":"NDC"}],"standard_charges":[{"gross_charge":1690.15,"setting":"both","billing_class":"facility"}]},{"description":"Clinolipid 20%","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2511629","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338954006","type":"NDC"}],"standard_charges":[{"gross_charge":282.72,"setting":"both","billing_class":"facility"}]},{"description":"SMOFLIPID 20% IV FAT EMULSION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2511631","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323082074","type":"NDC"}],"standard_charges":[{"gross_charge":156.0,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-M 200 41% 20mL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2511632","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141125","type":"NDC"}],"standard_charges":[{"gross_charge":531.24,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-M 300 61% 15mL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2511633","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"gross_charge":515.22,"setting":"both","billing_class":"facility"}]},{"description":"Cysto-Conray II (17.2%)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2511634","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":1881.0,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-370 76% 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511635","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131630","type":"NDC"}],"standard_charges":[{"gross_charge":152.88,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-370 76% 100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511636","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":304.98,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-M 200 41% 10 ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511637","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141111","type":"NDC"}],"standard_charges":[{"gross_charge":387.72,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-250 51% 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511638","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00270131705","type":"NDC"}],"standard_charges":[{"gross_charge":135.3,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-300 61% 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2511639","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":140.64,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-300 61% 100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2511640","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":274.8,"setting":"both","billing_class":"facility"}]},{"description":"MULTIHANCE 529MG/ML 15ML","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2511641","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516414","type":"NDC"}],"standard_charges":[{"gross_charge":510.66,"setting":"both","billing_class":"facility"}]},{"description":"MULTIHANCE 529MG/ML 20ML","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2511642","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":630.66,"setting":"both","billing_class":"facility"}]},{"description":"EOVIST 2.5MMOL/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511643","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":851.76,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOGRAFIN-DILUTE 18% 300ML","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"2511644","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270141030","type":"NDC"}],"standard_charges":[{"gross_charge":194.22,"setting":"both","billing_class":"facility"}]},{"description":"VUEWAY","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"2511645","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702540","type":"NDC"}],"standard_charges":[{"gross_charge":504.6,"setting":"both","billing_class":"facility"}]},{"description":"VUEWAY","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511646","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270703042","type":"NDC"}],"standard_charges":[{"gross_charge":669.78,"setting":"both","billing_class":"facility"}]},{"description":"Claritin-D 12 Hour","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511755","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802012246","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"setting":"both","billing_class":"facility"}]},{"description":"Yervoy","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511821","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":39947.4,"setting":"both","billing_class":"facility"}]},{"description":"Yervoy","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2511823","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232822","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Atrovent HFA 12.9Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511830","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597008717","type":"NDC"}],"standard_charges":[{"gross_charge":2404.22,"setting":"both","billing_class":"facility"}]},{"description":"Atrovent NEB 0.02%","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2511831","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Atrovent Nasal 0.03% 30mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2511832","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":191.88,"setting":"both","billing_class":"facility"}]},{"description":"Camptosar","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2511837","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970201","type":"NDC"}],"standard_charges":[{"gross_charge":40.02,"setting":"both","billing_class":"facility"}]},{"description":"Duoneb 0.5MG/3MG","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2511839","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Infed","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2511840","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":213.06,"setting":"both","billing_class":"facility"}]},{"description":"ONIVYDE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2511841","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":14530.0,"setting":"both","billing_class":"facility"}]},{"description":"Venofer","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2511844","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":350.4,"setting":"both","billing_class":"facility"}]},{"description":"ISONIAZID","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512034","type":"CDM"},{"code":"637","type":"RC"},{"code":"00555006602","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Isordil","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2512035","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001037300","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"setting":"both","billing_class":"facility"}]},{"description":"Ismo","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2512075","type":"CDM"},{"code":"637","type":"RC"},{"code":"62175010701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Imdur","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2512077","type":"CDM"},{"code":"637","type":"RC"},{"code":"59651054001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Imdur","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2512078","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ISOSULFAN BLUE 1%","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512091","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":5621.7,"setting":"both","billing_class":"facility"}]},{"description":"K-DUR","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2512156","type":"CDM"},{"code":"637","type":"RC"},{"code":"00245531901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ketalar PFS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512199","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092111944","type":"NDC"}],"standard_charges":[{"gross_charge":45.72,"setting":"both","billing_class":"facility"}]},{"description":"Ketalar MDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512200","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011310","type":"NDC"}],"standard_charges":[{"gross_charge":110.99,"setting":"both","billing_class":"facility"}]},{"description":"Ketalar","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512210","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143950810","type":"NDC"}],"standard_charges":[{"gross_charge":39.38,"setting":"both","billing_class":"facility"}]},{"description":"Nizoral 2% 120mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512235","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802046564","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"facility"}]},{"description":"Ketorolac Tromethamine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512259","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338006910","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"setting":"both","billing_class":"facility"}]},{"description":"Toradol","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512260","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075625","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Nizoral 2% 15Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512270","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168009915","type":"NDC"}],"standard_charges":[{"gross_charge":206.88,"setting":"both","billing_class":"facility"}]},{"description":"Toradol","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2512279","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378113401","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"setting":"both","billing_class":"facility"}]},{"description":"Toradol","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2512280","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011925","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Acular 0.5% 3mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512282","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":127.2,"setting":"both","billing_class":"facility"}]},{"description":"Normodyne","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512400","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Normodyne","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2512408","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"setting":"both","billing_class":"facility"}]},{"description":"Normodyne","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2512409","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":54.48,"setting":"both","billing_class":"facility"}]},{"description":"Normodyne","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2512410","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"00409226720","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"setting":"both","billing_class":"facility"}]},{"description":"Vimpat","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2512420","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"69543045510","type":"NDC"}],"standard_charges":[{"gross_charge":70.26,"setting":"both","billing_class":"facility"}]},{"description":"Vimpat","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2512421","type":"CDM"},{"code":"252","type":"RC"},{"code":"00131248060","type":"NDC"}],"standard_charges":[{"gross_charge":128.76,"setting":"both","billing_class":"facility"}]},{"description":"Vimpat","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2512422","type":"CDM"},{"code":"252","type":"RC"},{"code":"31722081260","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lactated Ringers","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2512448","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lactated Ringers","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2512450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Floranex Granules","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512470","type":"CDM"},{"code":"637","type":"RC"},{"code":"64980014612","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"setting":"both","billing_class":"facility"}]},{"description":"Culturelle Digestive Health Probiotic","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512471","type":"CDM"},{"code":"252","type":"RC"},{"code":"49100040007","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"setting":"both","billing_class":"facility"}]},{"description":"Cephulac","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2512500","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121115440","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"setting":"both","billing_class":"facility"}]},{"description":"LaMICtal","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2512545","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084031801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"LaMICtal","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512546","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084031901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Somatuline Depot","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2512556","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":43029.0,"setting":"both","billing_class":"facility"}]},{"description":"Lasinoh for Breast Feeding Mothers 7Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512557","type":"CDM"},{"code":"250","type":"RC"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"gross_charge":14.59,"setting":"both","billing_class":"facility"}]},{"description":"Prevacid Solutab","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2512563","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862089578","type":"NDC"}],"standard_charges":[{"gross_charge":31.18,"setting":"both","billing_class":"facility"}]},{"description":"Prevacid","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2512564","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687012301","type":"NDC"}],"standard_charges":[{"gross_charge":34.02,"setting":"both","billing_class":"facility"}]},{"description":"Xalatan 0.005% 2.5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512572","type":"CDM"},{"code":"637","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"setting":"both","billing_class":"facility"}]},{"description":"Lupron Depot","drug_information":{"unit":"22.5","type":"UN"},"code_information":[{"code":"2512575","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"00074334603","type":"NDC"}],"standard_charges":[{"gross_charge":27960.84,"setting":"both","billing_class":"facility"}]},{"description":"Lupron Depot","drug_information":{"unit":"45","type":"UN"},"code_information":[{"code":"2512579","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"00074347303","type":"NDC"}],"standard_charges":[{"gross_charge":55922.72,"setting":"both","billing_class":"facility"}]},{"description":"Lupron Depot","drug_information":{"unit":"3.75","type":"UN"},"code_information":[{"code":"2512581","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"00074364103","type":"NDC"}],"standard_charges":[{"gross_charge":8690.4,"setting":"both","billing_class":"facility"}]},{"description":"L.E.T.(LIDO-EPINEPH-TETRA) GEL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2512588","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266629001","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"}]},{"description":"Femara","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2512592","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729003410","type":"NDC"}],"standard_charges":[{"gross_charge":108.3,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2512593","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904635161","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512594","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":111.06,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2512597","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323071050","type":"NDC"}],"standard_charges":[{"gross_charge":128.1,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN CALCIUM","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2512598","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955501","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN CALCIUM","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2512599","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":358.62,"setting":"both","billing_class":"facility"}]},{"description":"Eligard","drug_information":{"unit":"45","type":"UN"},"code_information":[{"code":"2512616","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"gross_charge":13144.2,"setting":"both","billing_class":"facility"}]},{"description":"Arava-OUTPT PHA STOCK ONLY","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2512630","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155004303","type":"NDC"}],"standard_charges":[{"gross_charge":98.52,"setting":"both","billing_class":"facility"}]},{"description":"Keppra","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2512645","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904712461","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Keppra","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512646","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72205012007","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"setting":"both","billing_class":"facility"}]},{"description":"Keppra","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512648","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687024977","type":"NDC"}],"standard_charges":[{"gross_charge":42.66,"setting":"both","billing_class":"facility"}]},{"description":"KEPPRA 1GM/100mL BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2512649","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":129.0,"setting":"both","billing_class":"facility"}]},{"description":"KEPPRA 1,500MG/100mL BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2512650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050310","type":"NDC"}],"standard_charges":[{"gross_charge":109.14,"setting":"both","billing_class":"facility"}]},{"description":"Lupron Depot","drug_information":{"unit":"7.5","type":"UN"},"code_information":[{"code":"2512655","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"00074364203","type":"NDC"}],"standard_charges":[{"gross_charge":10355.95,"setting":"both","billing_class":"facility"}]},{"description":"Levophed","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2512660","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066099710","type":"NDC"}],"standard_charges":[{"gross_charge":16.67,"setting":"both","billing_class":"facility"}]},{"description":"Xopenex","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2512664","type":"CDM"},{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"Xopenex","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2512665","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"Xopenex HFA 15Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512667","type":"CDM"},{"code":"637","type":"RC"},{"code":"00591292754","type":"NDC"}],"standard_charges":[{"gross_charge":290.94,"setting":"both","billing_class":"facility"}]},{"description":"Levobunolol HCl 0.5% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512671","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"setting":"both","billing_class":"facility"}]},{"description":"Plan B One-Step","drug_information":{"unit":"1.5","type":"UN"},"code_information":[{"code":"2512674","type":"CDM"},{"code":"637","type":"RC"},{"code":"68180085211","type":"NDC"}],"standard_charges":[{"gross_charge":219.36,"setting":"both","billing_class":"facility"}]},{"description":"Levophed","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2512676","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"69374031625","type":"NDC"}],"standard_charges":[{"gross_charge":133.2,"setting":"both","billing_class":"facility"}]},{"description":"Levophed 8mg/D5W 250mL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2512678","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00338010820","type":"NDC"}],"standard_charges":[{"gross_charge":200.1,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2512682","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904635261","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2512684","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":36.72,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2512685","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"2512686","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000004824","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"}]},{"description":"Levaquin","drug_information":{"unit":"750","type":"UN"},"code_information":[{"code":"2512687","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904635361","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lovenox","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2512688","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":44.4,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2512690","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687046401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"88","type":"UN"},"code_information":[{"code":"2512691","type":"CDM"},{"code":"637","type":"RC"},{"code":"68180096809","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROXINE SODIUM","drug_information":{"unit":"175","type":"UN"},"code_information":[{"code":"2512692","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687054101","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"125","type":"UN"},"code_information":[{"code":"2512694","type":"CDM"},{"code":"637","type":"RC"},{"code":"68180097109","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2512695","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687045311","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2512697","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079044120","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512751","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023020101","type":"NDC"}],"standard_charges":[{"gross_charge":633.48,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2512780","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687049701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine HCl 1%","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512783","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"71351002125","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"112","type":"UN"},"code_information":[{"code":"2512785","type":"CDM"},{"code":"637","type":"RC"},{"code":"42292003920","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synthroid","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2512790","type":"CDM"},{"code":"637","type":"RC"},{"code":"68180097309","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Librax 5 mg-2.5 mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512820","type":"CDM"},{"code":"637","type":"RC"},{"code":"60219167701","type":"NDC"}],"standard_charges":[{"gross_charge":238.5,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine Viscous 2%","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2512829","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"setting":"both","billing_class":"facility"}]},{"description":"ICY HOT 4%-1% PATCH","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512831","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167017201","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine HCl 2% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512832","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071131","type":"NDC"}],"standard_charges":[{"gross_charge":39.28,"setting":"both","billing_class":"facility"}]},{"description":"LTA 4% 360 Kit","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2512833","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"gross_charge":181.2,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 5% 35.44GM JAR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512834","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine/Epi 1%-1:100,000","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2512836","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048217","type":"NDC"}],"standard_charges":[{"gross_charge":20.82,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine 2% Bolus","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512840","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":40.22,"setting":"both","billing_class":"facility"}]},{"description":"Uro-Jet 2% 10mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512844","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"facility"}]},{"description":"Glydo","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"2512845","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":35.7,"setting":"both","billing_class":"facility"}]},{"description":"Uro-Jet 2% 20 mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512846","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301505","type":"NDC"}],"standard_charges":[{"gross_charge":50.19,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1%-PE 1.5%-BSS  1 ML SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512847","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"71266636001","type":"NDC"}],"standard_charges":[{"gross_charge":109.56,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 2% PF","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2512850","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049697","type":"NDC"}],"standard_charges":[{"gross_charge":41.58,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE HCL 2% 40 MG/2 ML VL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2512851","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016402","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 1% MDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512860","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":7.68,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine HCl 4% Preservative Free","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512863","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":23.86,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine/Epinephrine 1.5%-1:200,000 5mL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512864","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":32.58,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 2% W/Epi 1:100,000","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512900","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine 2% PF","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512901","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"71266909001","type":"NDC"}],"standard_charges":[{"gross_charge":46.44,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine 2%","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2512902","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"71351002325","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine 4% Topical Patch","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512904","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00536120207","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"setting":"both","billing_class":"facility"}]},{"description":"Lidoderm 5%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512905","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"65162079104","type":"NDC"}],"standard_charges":[{"gross_charge":15.84,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine Jelly 2% 30mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2512960","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"gross_charge":428.7,"setting":"both","billing_class":"facility"}]},{"description":"AKTEN 3.5% GEL 1mL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2512961","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584079201","type":"NDC"}],"standard_charges":[{"gross_charge":129.84,"setting":"both","billing_class":"facility"}]},{"description":"Lidocaine Topical 4% 50mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513000","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":190.74,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 0.5% 50mL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2513010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 1% PF 30mL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2513051","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":19.62,"setting":"both","billing_class":"facility"}]},{"description":"Xylocaine 2%","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2513080","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":21.3,"setting":"both","billing_class":"facility"}]},{"description":"Zyvox","drug_information":{"unit":"600","type":"UN"},"code_information":[{"code":"2513169","type":"CDM"},{"code":"637","type":"RC"},{"code":"67877041984","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"setting":"both","billing_class":"facility"}]},{"description":"lisinopriL-OUTPATIENT PHARMACY STOCK ONLY","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2513170","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001033308","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"setting":"both","billing_class":"facility"}]},{"description":"Zyvox","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"2513171","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":66.67,"setting":"both","billing_class":"facility"}]},{"description":"Prinvil","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2513179","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687065621","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Eskalith","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2513180","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054852725","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"lisinopriL","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2513181","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687033301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Prinvil","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2513182","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001048600","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Eskalith CR","drug_information":{"unit":"450","type":"UN"},"code_information":[{"code":"2513186","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054002025","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Eskalith","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2513189","type":"CDM"},{"code":"637","type":"RC"},{"code":"00054852625","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cytomel","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2513192","type":"CDM"},{"code":"637","type":"RC"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"setting":"both","billing_class":"facility"}]},{"description":"Imodium","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2513260","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"setting":"both","billing_class":"facility"}]},{"description":"Claritin-D 24 Hour","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513267","type":"CDM"},{"code":"637","type":"RC"},{"code":"51660072415","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Claritin","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2513269","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084024801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ativan","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2513270","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ativan Intensol","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2513273","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ativan","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2513275","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"}]},{"description":"Ativan","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513280","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904600861","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ativan","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2513290","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"setting":"both","billing_class":"facility"}]},{"description":"Cozaar","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2513317","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"}]},{"description":"Cozaar","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2513318","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084034601","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"setting":"both","billing_class":"facility"}]},{"description":"Lotrisone 1%-0.05% 15Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513320","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":92.22,"setting":"both","billing_class":"facility"}]},{"description":"Lotrel 5/20mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513321","type":"CDM"},{"code":"637","type":"RC"},{"code":"55111034001","type":"NDC"}],"standard_charges":[{"gross_charge":87.66,"setting":"both","billing_class":"facility"}]},{"description":"Latuda","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2513357","type":"CDM"},{"code":"252","type":"RC"},{"code":"62332049430","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Latuda","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2513358","type":"CDM"},{"code":"252","type":"RC"},{"code":"62332049530","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Latuda","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2513359","type":"CDM"},{"code":"252","type":"RC"},{"code":"62332049730","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Latuda","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2513360","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332049630","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ReblozyL","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2513361","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"59572071101","type":"NDC"}],"standard_charges":[{"gross_charge":20162.45,"setting":"both","billing_class":"facility"}]},{"description":"ReblozyL","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2513362","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"gross_charge":54438.39,"setting":"both","billing_class":"facility"}]},{"description":"Amitiza","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"2513363","type":"CDM"},{"code":"250","type":"RC"},{"code":"00254302802","type":"NDC"}],"standard_charges":[{"gross_charge":40.08,"setting":"both","billing_class":"facility"}]},{"description":"Amitiza","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"2513364","type":"CDM"},{"code":"637","type":"RC"},{"code":"00254302902","type":"NDC"}],"standard_charges":[{"gross_charge":40.08,"setting":"both","billing_class":"facility"}]},{"description":"Zepzelca","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2513365","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9223","type":"HCPCS"},{"code":"68727071201","type":"NDC"}],"standard_charges":[{"gross_charge":36495.0,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Citrate","drug_information":{"unit":"296","type":"ML"},"code_information":[{"code":"2513420","type":"CDM"},{"code":"637","type":"RC"},{"code":"69452038998","type":"NDC"}],"standard_charges":[{"gross_charge":111.72,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2513465","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":49.32,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2513466","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409216817","type":"NDC"}],"standard_charges":[{"gross_charge":54.3,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2513467","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2513468","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055300","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2513469","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409205020","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"setting":"both","billing_class":"facility"}]},{"description":"Magnesium Sulfate","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2513470","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":14.82,"setting":"both","billing_class":"facility"}]},{"description":"Mag-Ox","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2513475","type":"CDM"},{"code":"637","type":"RC"},{"code":"64980033901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Mannitol 25%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2513510","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"63323002425","type":"NDC"}],"standard_charges":[{"gross_charge":36.36,"setting":"both","billing_class":"facility"}]},{"description":"Marinol","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2513525","type":"CDM"},{"code":"637","type":"RC"},{"code":"42858086706","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"setting":"both","billing_class":"facility"}]},{"description":"Maxipime","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513526","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"gross_charge":41.04,"setting":"both","billing_class":"facility"}]},{"description":"Maxipime","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2513527","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"gross_charge":70.56,"setting":"both","billing_class":"facility"}]},{"description":"Maxitrol 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513530","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":86.16,"setting":"both","billing_class":"facility"}]},{"description":"Maxitrol 3.5Gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513540","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":86.16,"setting":"both","billing_class":"facility"}]},{"description":"Antivert","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2513590","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687073001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Antivert","drug_information":{"unit":"12.5","type":"UN"},"code_information":[{"code":"2513591","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Provera","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2513635","type":"CDM"},{"code":"637","type":"RC"},{"code":"59762005501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Depo-Provera","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2513636","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"67457088701","type":"NDC"}],"standard_charges":[{"gross_charge":167.1,"setting":"both","billing_class":"facility"}]},{"description":"Megace","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2513667","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"gross_charge":22.34,"setting":"both","billing_class":"facility"}]},{"description":"Megace","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2513670","type":"CDM"},{"code":"637","type":"RC"},{"code":"00555060702","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"GNP Melatonin 3mg Tab","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2513695","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268052415","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Mobic","drug_information":{"unit":"7.5","type":"UN"},"code_information":[{"code":"2513703","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268052515","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"setting":"both","billing_class":"facility"}]},{"description":"Namenda","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2513704","type":"CDM"},{"code":"637","type":"RC"},{"code":"00591387044","type":"NDC"}],"standard_charges":[{"gross_charge":36.6,"setting":"both","billing_class":"facility"}]},{"description":"Namenda","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2513706","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687018457","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"BIOFREEZE 4% 89mL 3oz--OUTPT ONLY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2513745","type":"CDM"},{"code":"250","type":"RC"},{"code":"59316020510","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Demerol","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2513770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"setting":"both","billing_class":"facility"}]},{"description":"Merrem","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2513888","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"72485041210","type":"NDC"}],"standard_charges":[{"gross_charge":22.78,"setting":"both","billing_class":"facility"}]},{"description":"Asacol HD","drug_information":{"unit":"800","type":"UN"},"code_information":[{"code":"2513891","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687040825","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"}]},{"description":"Mesnex","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2513897","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"00338130501","type":"NDC"}],"standard_charges":[{"gross_charge":96.84,"setting":"both","billing_class":"facility"}]},{"description":"Glucophage XR","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2513951","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687064001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glucophage","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2513952","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687015501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Glucophage","drug_information":{"unit":"850","type":"UN"},"code_information":[{"code":"2513953","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687014301","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"setting":"both","billing_class":"facility"}]},{"description":"Glucophage","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2513954","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687016201","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"setting":"both","billing_class":"facility"}]},{"description":"Provocholine","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2513956","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281010006","type":"NDC"}],"standard_charges":[{"gross_charge":766.26,"setting":"both","billing_class":"facility"}]},{"description":"Methadose","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2513957","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"METHACHOLINE CHLORIDE","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"2513959","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281011006","type":"NDC"}],"standard_charges":[{"gross_charge":766.26,"setting":"both","billing_class":"facility"}]},{"description":"Methergine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2513960","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"gross_charge":142.26,"setting":"both","billing_class":"facility"}]},{"description":"Methergine","drug_information":{"unit":"0.2","type":"UN"},"code_information":[{"code":"2513970","type":"CDM"},{"code":"637","type":"RC"},{"code":"70010078628","type":"NDC"}],"standard_charges":[{"gross_charge":69.21,"setting":"both","billing_class":"facility"}]},{"description":"Provayblue 0.5%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2514001","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":1136.88,"setting":"both","billing_class":"facility"}]},{"description":"Solu-Medrol","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2514040","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"gross_charge":51.42,"setting":"both","billing_class":"facility"}]},{"description":"Relistor","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2514061","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":961.86,"setting":"both","billing_class":"facility"}]},{"description":"SOLU-MedroL","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2514067","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009069801","type":"NDC"}],"standard_charges":[{"gross_charge":215.04,"setting":"both","billing_class":"facility"}]},{"description":"Methotrexate","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2514115","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"00555057235","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ritalin","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2514163","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"setting":"both","billing_class":"facility"}]},{"description":"Medrol","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2514167","type":"CDM"},{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"68382091601","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"setting":"both","billing_class":"facility"}]},{"description":"Aldomet","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2514180","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729003016","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Methadose","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2514203","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406577101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Solu-Medrol","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2514220","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"gross_charge":38.82,"setting":"both","billing_class":"facility"}]},{"description":"SOLU-MedroL","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2514251","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":145.68,"setting":"both","billing_class":"facility"}]},{"description":"Methotrexate","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2514299","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703040841","type":"NDC"}],"standard_charges":[{"gross_charge":220.38,"setting":"both","billing_class":"facility"}]},{"description":"Methotrexate","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2514300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"setting":"both","billing_class":"facility"}]},{"description":"DEPO-MedroL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2514320","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"}]},{"description":"DEPO-MedroL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2514321","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":37.44,"setting":"both","billing_class":"facility"}]},{"description":"Tapazole","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2514345","type":"CDM"},{"code":"637","type":"RC"},{"code":"23155007101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zaroxolyn","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2514470","type":"CDM"},{"code":"637","type":"RC"},{"code":"00185505001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lopressor","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2514474","type":"CDM"},{"code":"250","type":"RC"},{"code":"62584026501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Toprol XL","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2514477","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268054015","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lopressor","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2514480","type":"CDM"},{"code":"637","type":"RC"},{"code":"62584026601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL TARTRATE","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2514484","type":"CDM"},{"code":"250","type":"RC"},{"code":"62584026701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Toprol XL","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2514485","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687041301","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"setting":"both","billing_class":"facility"}]},{"description":"Toprol XL","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2514486","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687040201","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"setting":"both","billing_class":"facility"}]},{"description":"Lopressor","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2514500","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"setting":"both","billing_class":"facility"}]},{"description":"Zaroxolyn","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2514520","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079002420","type":"NDC"}],"standard_charges":[{"gross_charge":22.38,"setting":"both","billing_class":"facility"}]},{"description":"Reglan","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2514530","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"setting":"both","billing_class":"facility"}]},{"description":"Reglan","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2514550","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Flagyl","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2514560","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687052601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Flagyl","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2514570","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"setting":"both","billing_class":"facility"}]},{"description":"Mycamine","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2514627","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"00143936201","type":"NDC"}],"standard_charges":[{"gross_charge":215.58,"setting":"both","billing_class":"facility"}]},{"description":"Monistat Vaginal Cream 2% 45GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2514690","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385059029","type":"NDC"}],"standard_charges":[{"gross_charge":24.12,"setting":"both","billing_class":"facility"}]},{"description":"Avitene Microfibrillar Collagen Flour","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2514721","type":"CDM"},{"code":"270","type":"RC"},{"code":"53276101001","type":"NDC"}],"standard_charges":[{"gross_charge":784.89,"setting":"both","billing_class":"facility"}]},{"description":"Versed","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2514772","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Versed","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2514780","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605910","type":"NDC"}],"standard_charges":[{"gross_charge":8.34,"setting":"both","billing_class":"facility"}]},{"description":"Versed","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2514781","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":41.4,"setting":"both","billing_class":"facility"}]},{"description":"Midodrine","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2514786","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687038701","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"setting":"both","billing_class":"facility"}]},{"description":"Midodrine","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2514787","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687040925","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"setting":"both","billing_class":"facility"}]},{"description":"Milk of Magnesia","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2514791","type":"CDM"},{"code":"637","type":"RC"},{"code":"66689005399","type":"NDC"}],"standard_charges":[{"gross_charge":15.78,"setting":"both","billing_class":"facility"}]},{"description":"MURI-LUBE MINERAL OIL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2514801","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"setting":"both","billing_class":"facility"}]},{"description":"Mineral Oil","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2514810","type":"CDM"},{"code":"637","type":"RC"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"setting":"both","billing_class":"facility"}]},{"description":"MIRTAZAPINE-OUTPT PHA STOCK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2514834","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000930","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"setting":"both","billing_class":"facility"}]},{"description":"Remeron Soltab (ODT)","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2514835","type":"CDM"},{"code":"637","type":"RC"},{"code":"57237001106","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"setting":"both","billing_class":"facility"}]},{"description":"MIRTAZAPINE-OUTPT PHA STOCK","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2514836","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107003105","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"setting":"both","billing_class":"facility"}]},{"description":"Mirtazapine","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2514837","type":"CDM"},{"code":"637","type":"RC"},{"code":"66993060630","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cytotec","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2514840","type":"CDM"},{"code":"637","type":"RC"},{"code":"59762500802","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"setting":"both","billing_class":"facility"}]},{"description":"Cytotec 25mcg CUT-TAB from 100mcg","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2514842","type":"CDM"},{"code":"637","type":"RC"},{"code":"59762500701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 25 MCG"}]},{"description":"Cytotec","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2514843","type":"CDM"},{"code":"637","type":"RC"},{"code":"59762500701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Mutamycin","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2514861","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"00143927901","type":"NDC"}],"standard_charges":[{"gross_charge":3057.84,"setting":"both","billing_class":"facility"}]},{"description":"Mutamycin","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2514862","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"00143928001","type":"NDC"}],"standard_charges":[{"gross_charge":5559.7,"setting":"both","billing_class":"facility"}]},{"description":"Mitosol","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2514864","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7315","type":"HCPCS"},{"code":"49771000201","type":"NDC"}],"standard_charges":[{"gross_charge":2365.0,"setting":"both","billing_class":"facility"}]},{"description":"Mutamycin","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2514890","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729011505","type":"NDC"}],"standard_charges":[{"gross_charge":1498.53,"setting":"both","billing_class":"facility"}]},{"description":"MMR","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2514910","type":"CDM"},{"code":"636","type":"RC"},{"code":"90707","type":"HCPCS"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"gross_charge":1115.4,"setting":"both","billing_class":"facility"}]},{"description":"Provigil","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2514925","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505252703","type":"NDC"}],"standard_charges":[{"gross_charge":239.4,"setting":"both","billing_class":"facility"}]},{"description":"Mometasone Furoate 0.1%","drug_information":{"unit":"15","type":"GM"},"code_information":[{"code":"2514966","type":"CDM"},{"code":"637","type":"RC"},{"code":"00713063415","type":"NDC"}],"standard_charges":[{"gross_charge":174.96,"setting":"both","billing_class":"facility"}]},{"description":"Mometasone Furoate 0.1% 30mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2514967","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802011859","type":"NDC"}],"standard_charges":[{"gross_charge":57.96,"setting":"both","billing_class":"facility"}]},{"description":"Singulair","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2514998","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084087501","type":"NDC"}],"standard_charges":[{"gross_charge":33.06,"setting":"both","billing_class":"facility"}]},{"description":"MSIR","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2515005","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687061701","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"setting":"both","billing_class":"facility"}]},{"description":"Morphine Sulfate PCA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2515015","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76329191101","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"}]},{"description":"Morphine Sulfate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2515016","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"}]},{"description":"Morphine Sulfate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2515040","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"setting":"both","billing_class":"facility"}]},{"description":"MS Contin","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2515051","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406831562","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"setting":"both","billing_class":"facility"}]},{"description":"Roxanol","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2515059","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094004558","type":"NDC"}],"standard_charges":[{"gross_charge":21.3,"setting":"both","billing_class":"facility"}]},{"description":"Duramorph","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2515077","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"00641602010","type":"NDC"}],"standard_charges":[{"gross_charge":173.76,"setting":"both","billing_class":"facility"}]},{"description":"Morphine Sulfate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2515080","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":12.78,"setting":"both","billing_class":"facility"}]},{"description":"MS Contin","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2515090","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406833062","type":"NDC"}],"standard_charges":[{"gross_charge":20.28,"setting":"both","billing_class":"facility"}]},{"description":"Morphine Sulfate","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2515125","type":"CDM"},{"code":"637","type":"RC"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"setting":"both","billing_class":"facility"}]},{"description":"MS Contin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2515145","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406839062","type":"NDC"}],"standard_charges":[{"gross_charge":45.84,"setting":"both","billing_class":"facility"}]},{"description":"Vigamox 0.5% 0.5mL from 3mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515154","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":277.8,"setting":"both","billing_class":"facility"}]},{"description":"MOXIFLOXACIN 0.1% 0.3ML SYRINGE","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2515155","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"71266861301","type":"NDC"}],"standard_charges":[{"gross_charge":182.52,"setting":"both","billing_class":"facility"}]},{"description":"MVI","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2515180","type":"CDM"},{"code":"637","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"gross_charge":63.40,"setting":"both","billing_class":"facility"}]},{"description":"Bactroban Ointment 2% 22gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515300","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"setting":"both","billing_class":"facility"}]},{"description":"CellCept","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2515304","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687049401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"CellCept","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2515306","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687043801","type":"NDC"}],"standard_charges":[{"gross_charge":9.36,"setting":"both","billing_class":"facility"}]},{"description":"Neo-Synephrine 10% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515317","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":223.5,"setting":"both","billing_class":"facility"}]},{"description":"Neupogen","drug_information":{"unit":"1.6","type":"ML"},"code_information":[{"code":"2515319","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"gross_charge":2660.81,"setting":"both","billing_class":"facility"}]},{"description":"Neosporin Oint 14g","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515321","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001048346","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"setting":"both","billing_class":"facility"}]},{"description":"Neo-Synephrine Es 1% 30mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515322","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122068903","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"setting":"both","billing_class":"facility"}]},{"description":"Revia","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2515327","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084029121","type":"NDC"}],"standard_charges":[{"gross_charge":25.86,"setting":"both","billing_class":"facility"}]},{"description":"Maalox Plus","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2515361","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":22.74,"setting":"both","billing_class":"facility"}]},{"description":"Mylanta Gas","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2515380","type":"CDM"},{"code":"637","type":"RC"},{"code":"24385011878","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Relafen","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2515415","type":"CDM"},{"code":"637","type":"RC"},{"code":"69097096507","type":"NDC"}],"standard_charges":[{"gross_charge":8.04,"setting":"both","billing_class":"facility"}]},{"description":"Unipen","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515440","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567022110","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"setting":"both","billing_class":"facility"}]},{"description":"Unipen","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2515450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67850003210","type":"NDC"}],"standard_charges":[{"gross_charge":155.4,"setting":"both","billing_class":"facility"}]},{"description":"Nubain","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2515500","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"00409146501","type":"NDC"}],"standard_charges":[{"gross_charge":46.02,"setting":"both","billing_class":"facility"}]},{"description":"Narcan","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2515560","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"setting":"both","billing_class":"facility"}]},{"description":"Narcan","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2515570","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"43598075058","type":"NDC"}],"standard_charges":[{"gross_charge":188.1,"setting":"both","billing_class":"facility"}]},{"description":"Naprosyn","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2515675","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687049101","type":"NDC"}],"standard_charges":[{"gross_charge":8.04,"setting":"both","billing_class":"facility"}]},{"description":"Tysabri","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2515683","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":38419.74,"setting":"both","billing_class":"facility"}]},{"description":"Mycifradin","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2515760","type":"CDM"},{"code":"637","type":"RC"},{"code":"39822031005","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"setting":"both","billing_class":"facility"}]},{"description":"Prostigmine","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2515781","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"setting":"both","billing_class":"facility"}]},{"description":"NEOSTIGMINE METHYLSULFATE","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2515782","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"71266200302","type":"NDC"}],"standard_charges":[{"gross_charge":82.98,"setting":"both","billing_class":"facility"}]},{"description":"Nephrocaps","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515797","type":"CDM"},{"code":"637","type":"RC"},{"code":"63044062201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Nephron FA","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515799","type":"CDM"},{"code":"637","type":"RC"},{"code":"59528445601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Neutraphos Pack","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515820","type":"CDM"},{"code":"637","type":"RC"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Niaspan","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2515865","type":"CDM"},{"code":"637","type":"RC"},{"code":"47335053981","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Cardene","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2515869","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":127.44,"setting":"both","billing_class":"facility"}]},{"description":"CARDENE-NACL 20 MG/200 ML SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2515870","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143963410","type":"NDC"}],"standard_charges":[{"gross_charge":487.92,"setting":"both","billing_class":"facility"}]},{"description":"Nicoderm CQ","drug_information":{"unit":"7","type":"UN"},"code_information":[{"code":"2515872","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001043290","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"setting":"both","billing_class":"facility"}]},{"description":"Nicoderm CQ","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"2515873","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001043390","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"setting":"both","billing_class":"facility"}]},{"description":"Nicoderm CQ","drug_information":{"unit":"21","type":"UN"},"code_information":[{"code":"2515875","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001043490","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"setting":"both","billing_class":"facility"}]},{"description":"Nicorette Gum","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2515900","type":"CDM"},{"code":"637","type":"RC"},{"code":"S4995","type":"HCPCS"},{"code":"00536136223","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Procardia","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2515910","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315021101","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"setting":"both","billing_class":"facility"}]},{"description":"Nymalize","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2515930","type":"CDM"},{"code":"637","type":"RC"},{"code":"69452020920","type":"NDC"}],"standard_charges":[{"gross_charge":110.46,"setting":"both","billing_class":"facility"}]},{"description":"Procardia XL","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2515936","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268059815","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"}]},{"description":"Procardia XL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2515937","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"setting":"both","billing_class":"facility"}]},{"description":"NIPRIDE RTU 20 MG/100 ML VIAL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2515940","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754102901","type":"NDC"}],"standard_charges":[{"gross_charge":270.0,"setting":"both","billing_class":"facility"}]},{"description":"NTG 25 MG/250 ML IN D5W","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2515942","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338104702","type":"NDC"}],"standard_charges":[{"gross_charge":122.94,"setting":"both","billing_class":"facility"}]},{"description":"Nitro Patch","drug_information":{"unit":"0.4","type":"UN"},"code_information":[{"code":"2515945","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378911293","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"setting":"both","billing_class":"facility"}]},{"description":"Nitrol 2% 1 Gm pkt","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2515947","type":"CDM"},{"code":"250","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":18.18,"setting":"both","billing_class":"facility"}]},{"description":"Macrobid","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2515951","type":"CDM"},{"code":"637","type":"RC"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Macrodantin","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2515980","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687047201","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"setting":"both","billing_class":"facility"}]},{"description":"Pamelor","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2516191","type":"CDM"},{"code":"637","type":"RC"},{"code":"51672400401","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"setting":"both","billing_class":"facility"}]},{"description":"Pamelor","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2516194","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"setting":"both","billing_class":"facility"}]},{"description":"Pamelor","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2516196","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093081001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Nitro Patch","drug_information":{"unit":"0.1","type":"UN"},"code_information":[{"code":"2516305","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"setting":"both","billing_class":"facility"}]},{"description":"Nitro Patch","drug_information":{"unit":"0.2","type":"UN"},"code_information":[{"code":"2516306","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378910493","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"setting":"both","billing_class":"facility"}]},{"description":"Nitrostat","drug_information":{"unit":"0.4","type":"UN"},"code_information":[{"code":"2516340","type":"CDM"},{"code":"637","type":"RC"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"setting":"both","billing_class":"facility"}]},{"description":"Nitrobid","drug_information":{"unit":"6.5","type":"UN"},"code_information":[{"code":"2516440","type":"CDM"},{"code":"637","type":"RC"},{"code":"49483022210","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Opdivo","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2516481","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":6489.45,"setting":"both","billing_class":"facility"}]},{"description":"Opdivo","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2516482","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":16223.55,"setting":"both","billing_class":"facility"}]},{"description":"Opdivo","drug_information":{"unit":"24","type":"ML"},"code_information":[{"code":"2516485","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"gross_charge":35042.98,"setting":"both","billing_class":"facility"}]},{"description":"Spinraza","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2516501","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2326","type":"HCPCS"},{"code":"64406005801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"QALSODY","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2516503","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1304","type":"HCPCS"},{"code":"64406010901","type":"NDC"}],"standard_charges":[{"gross_charge":65956.05,"setting":"both","billing_class":"facility"}]},{"description":"Nystatin 500,000un/5mL UDC","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2516505","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687080017","type":"NDC"}],"standard_charges":[{"gross_charge":6.70,"setting":"both","billing_class":"facility"}]},{"description":"Mycostatin Cream 15 GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516530","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713067815","type":"NDC"}],"standard_charges":[{"gross_charge":78.6,"setting":"both","billing_class":"facility"}]},{"description":"Mycostatin Powder 15 GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516585","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":31.92,"setting":"both","billing_class":"facility"}]},{"description":"Nystatin 30 GM Powder","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516586","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907006030","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"setting":"both","billing_class":"facility"}]},{"description":"NYSTOP 60 gm Powder","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516587","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"setting":"both","billing_class":"facility"}]},{"description":"Gazyva","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2516591","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":38757.24,"setting":"both","billing_class":"facility"}]},{"description":"BOTOX","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2516630","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"00023392102","type":"NDC"}],"standard_charges":[{"gross_charge":6460.0,"setting":"both","billing_class":"facility"}]},{"description":"OCREVUS ZUNOVO 920 MG-23,000","drug_information":{"unit":"23","type":"ML"},"code_information":[{"code":"2516645","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"50242055401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ocrevus","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2516646","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2350","type":"HCPCS"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":92884.32,"setting":"both","billing_class":"facility"}]},{"description":"Briumvi","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"2516647","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2329","type":"HCPCS"},{"code":"73150015006","type":"NDC"}],"standard_charges":[{"gross_charge":49995.0,"setting":"both","billing_class":"facility"}]},{"description":"Sandostatin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2516651","type":"CDM"},{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":298.14,"setting":"both","billing_class":"facility"}]},{"description":"Zofran","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2516652","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sandostatin LAR","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2516654","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"00078082581","type":"NDC"}],"standard_charges":[{"gross_charge":30017.84,"setting":"both","billing_class":"facility"}]},{"description":"Sandostatin LAR","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2516655","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"00078081881","type":"NDC"}],"standard_charges":[{"gross_charge":23081.5,"setting":"both","billing_class":"facility"}]},{"description":"Sandostatin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2516656","type":"CDM"},{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":9.17,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2516657","type":"CDM"},{"code":"637","type":"RC"},{"code":"43598016430","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Floxin OTIC 0.3% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516658","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060915","type":"NDC"}],"standard_charges":[{"gross_charge":61.62,"setting":"both","billing_class":"facility"}]},{"description":"Zofran","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2516666","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475901","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"setting":"both","billing_class":"facility"}]},{"description":"Prilosec","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2516667","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687060801","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"setting":"both","billing_class":"facility"}]},{"description":"Prilosec","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2516668","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084012801","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"setting":"both","billing_class":"facility"}]},{"description":"Norflex","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2516679","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618210","type":"NDC"}],"standard_charges":[{"gross_charge":78.06,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2516682","type":"CDM"},{"code":"637","type":"RC"},{"code":"55111016330","type":"NDC"}],"standard_charges":[{"gross_charge":67.2,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2516683","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505311300","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa Zydis","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2516684","type":"CDM"},{"code":"637","type":"RC"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa Zydis","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2516686","type":"CDM"},{"code":"637","type":"RC"},{"code":"64380017302","type":"NDC"}],"standard_charges":[{"gross_charge":6.10,"setting":"both","billing_class":"facility"}]},{"description":"Patanol 0.1% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516689","type":"CDM"},{"code":"637","type":"RC"},{"code":"00065427401","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"setting":"both","billing_class":"facility"}]},{"description":"Zyprexa Intramuscular","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2516691","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00517095501","type":"NDC"}],"standard_charges":[{"gross_charge":236.94,"setting":"both","billing_class":"facility"}]},{"description":"Zofran","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2516692","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084022101","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"setting":"both","billing_class":"facility"}]},{"description":"Zofran","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2516694","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68084022001","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"setting":"both","billing_class":"facility"}]},{"description":"Zofran ODT","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2516697","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8597","type":"HCPCS"},{"code":"57237007710","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Xolair","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2516701","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242004062","type":"NDC"}],"standard_charges":[{"gross_charge":6924.8,"setting":"both","billing_class":"facility"}]},{"description":"Lovaza","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2516711","type":"CDM"},{"code":"637","type":"RC"},{"code":"42806055212","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"VISIPAQUE 320 MG/ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2516714","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317","type":"NDC"}],"standard_charges":[{"gross_charge":786.96,"setting":"both","billing_class":"facility"}]},{"description":"ORBACTIV","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2516841","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2407","type":"HCPCS"},{"code":"70842014003","type":"NDC"}],"standard_charges":[{"gross_charge":4627.85,"setting":"both","billing_class":"facility"}]},{"description":"Kimyrsa","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2516843","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2406","type":"HCPCS"},{"code":"70842022501","type":"NDC"}],"standard_charges":[{"gross_charge":14167.8,"setting":"both","billing_class":"facility"}]},{"description":"Ora-Plus","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2516872","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574030316","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ora-Sweet SF","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2516873","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574030216","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tamiflu","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2516901","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380079901","type":"NDC"}],"standard_charges":[{"gross_charge":9.13,"setting":"both","billing_class":"facility"}]},{"description":"Tamiflu 6mg/mL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2516902","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710116506","type":"NDC"}],"standard_charges":[{"gross_charge":6.10,"setting":"both","billing_class":"facility"}]},{"description":"Tamiflu","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2516904","type":"CDM"},{"code":"252","type":"RC"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":85.08,"setting":"both","billing_class":"facility"}]},{"description":"Mannitol 20%","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2516905","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990771503","type":"NDC"}],"standard_charges":[{"gross_charge":114.3,"setting":"both","billing_class":"facility"}]},{"description":"ACTIVASE","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2516991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":38215.58,"setting":"both","billing_class":"facility"}]},{"description":"Trileptal","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2516998","type":"CDM"},{"code":"637","type":"RC"},{"code":"68462013701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Trileptal","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2516999","type":"CDM"},{"code":"637","type":"RC"},{"code":"68462013801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Oxaliplatin","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2517001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"facility"}]},{"description":"Eloxatin","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2517005","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":70.86,"setting":"both","billing_class":"facility"}]},{"description":"Ditropan","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2517050","type":"CDM"},{"code":"637","type":"RC"},{"code":"69315018201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ditropan XL","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2517051","type":"CDM"},{"code":"637","type":"RC"},{"code":"27241015504","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Myrbetriq--OUTPATIENT PHARMACY ONLY","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2517052","type":"CDM"},{"code":"637","type":"RC"},{"code":"00469260230","type":"NDC"}],"standard_charges":[{"gross_charge":92.04,"setting":"both","billing_class":"facility"}]},{"description":"Percocet 5/325","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517060","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"setting":"both","billing_class":"facility"}]},{"description":"Percocet 7.5/325","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517061","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406052262","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"setting":"both","billing_class":"facility"}]},{"description":"Percocet 10mg/325mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517062","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406052362","type":"NDC"}],"standard_charges":[{"gross_charge":9.10,"setting":"both","billing_class":"facility"}]},{"description":"Oxycontin ER","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2517065","type":"CDM"},{"code":"637","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":32.82,"setting":"both","billing_class":"facility"}]},{"description":"Oxycontin ER","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2517067","type":"CDM"},{"code":"637","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":61.2,"setting":"both","billing_class":"facility"}]},{"description":"Oxymetazoline 0.05% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517080","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904676130","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"setting":"both","billing_class":"facility"}]},{"description":"Pit Bag","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2517095","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"70092106708","type":"NDC"}],"standard_charges":[{"gross_charge":127.32,"setting":"both","billing_class":"facility"}]},{"description":"Pitocin","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2517100","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"setting":"both","billing_class":"facility"}]},{"description":"Oxy IR","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2517103","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084035401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Invega Sustenna","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2517111","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056301","type":"NDC"}],"standard_charges":[{"gross_charge":11190.1,"setting":"both","billing_class":"facility"}]},{"description":"Invega Sustenna","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2517112","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"gross_charge":17221.15,"setting":"both","billing_class":"facility"}]},{"description":"Invega","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2517113","type":"CDM"},{"code":"637","type":"RC"},{"code":"65162028103","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"setting":"both","billing_class":"facility"}]},{"description":"Invega","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"2517114","type":"CDM"},{"code":"637","type":"RC"},{"code":"27808022401","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"setting":"both","billing_class":"facility"}]},{"description":"Aloxi","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2517115","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323067305","type":"NDC"}],"standard_charges":[{"gross_charge":53.28,"setting":"both","billing_class":"facility"}]},{"description":"Abraxane","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2517123","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":7623.8,"setting":"both","billing_class":"facility"}]},{"description":"Aredia","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2517126","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":84.12,"setting":"both","billing_class":"facility"}]},{"description":"Taxol MDV","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2517129","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":427.8,"setting":"both","billing_class":"facility"}]},{"description":"Pancreaze 4200","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517145","type":"CDM"},{"code":"637","type":"RC"},{"code":"62541040210","type":"NDC"}],"standard_charges":[{"gross_charge":7.92,"setting":"both","billing_class":"facility"}]},{"description":"PANCREAZE DR 10,500 UNIT CAP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2517146","type":"CDM"},{"code":"637","type":"RC"},{"code":"62541040310","type":"NDC"}],"standard_charges":[{"gross_charge":18.40,"setting":"both","billing_class":"facility"}]},{"description":"Vectibix","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2517147","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":8741.25,"setting":"both","billing_class":"facility"}]},{"description":"Protonix","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2517149","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288060010","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"setting":"both","billing_class":"facility"}]},{"description":"Pantoprazole Sodium","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2517150","type":"CDM"},{"code":"637","type":"RC"},{"code":"35573042880","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vectibix","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2517152","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":31468.36,"setting":"both","billing_class":"facility"}]},{"description":"Zemplar","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2517184","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"00074463701","type":"NDC"}],"standard_charges":[{"gross_charge":36.36,"setting":"both","billing_class":"facility"}]},{"description":"Zemplar","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517186","type":"CDM"},{"code":"637","type":"RC"},{"code":"49483068703","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"facility"}]},{"description":"Paxil","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2517204","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084004501","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"setting":"both","billing_class":"facility"}]},{"description":"Paxil","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2517205","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382000106","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Paxil","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2517208","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268064015","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ziextenzo","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517235","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5120","type":"HCPCS"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":18940.7,"setting":"both","billing_class":"facility"}]},{"description":"UDENYCA","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517236","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"gross_charge":6151.9,"setting":"both","billing_class":"facility"}]},{"description":"Neulasta","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517237","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":27870.16,"setting":"both","billing_class":"facility"}]},{"description":"Neulasta OnPro Kit","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517238","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":27870.16,"setting":"both","billing_class":"facility"}]},{"description":"FULPHILA","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517239","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":5261.08,"setting":"both","billing_class":"facility"}]},{"description":"NYVEPRIA","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2517240","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5122","type":"HCPCS"},{"code":"00069032401","type":"NDC"}],"standard_charges":[{"gross_charge":18559.4,"setting":"both","billing_class":"facility"}]},{"description":"Alimta","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2517241","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"71288016750","type":"NDC"}],"standard_charges":[{"gross_charge":833.4,"setting":"both","billing_class":"facility"}]},{"description":"Keytruda","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2517243","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":26019.36,"setting":"both","billing_class":"facility"}]},{"description":"Alimta","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2517247","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"71288016610","type":"NDC"}],"standard_charges":[{"gross_charge":77.82,"setting":"both","billing_class":"facility"}]},{"description":"Pfizerpen","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2517289","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":31.38,"setting":"both","billing_class":"facility"}]},{"description":"Penicillin VK Susp 100mL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2517310","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093412773","type":"NDC"}],"standard_charges":[{"gross_charge":43.8,"setting":"both","billing_class":"facility"}]},{"description":"Veetids","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2517320","type":"CDM"},{"code":"637","type":"RC"},{"code":"00143983701","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"setting":"both","billing_class":"facility"}]},{"description":"Pentasa","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2517372","type":"CDM"},{"code":"637","type":"RC"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":18.24,"setting":"both","billing_class":"facility"}]},{"description":"Trental","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2517460","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904544861","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Peppermint Spirit","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2517461","type":"CDM"},{"code":"250","type":"RC"},{"code":"00395224391","type":"NDC"}],"standard_charges":[{"gross_charge":58.32,"setting":"both","billing_class":"facility"}]},{"description":"PENTAM 300","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2517563","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323011310","type":"NDC"}],"standard_charges":[{"gross_charge":1001.34,"setting":"both","billing_class":"facility"}]},{"description":"Definity","drug_information":{"unit":"2.2","type":"ML"},"code_information":[{"code":"2517564","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":2106.17,"setting":"both","billing_class":"facility"}]},{"description":"Perjeta","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"2517566","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":30692.20,"setting":"both","billing_class":"facility"}]},{"description":"PHESGO 600-600 MG-20,000 UNIT","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2517568","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":41747.94,"setting":"both","billing_class":"facility"}]},{"description":"PHESGO 1,200-600MG-30,000 UNIT","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2517569","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":62624.38,"setting":"both","billing_class":"facility"}]},{"description":"Permethrin 5% 60 GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517574","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802026937","type":"NDC"}],"standard_charges":[{"gross_charge":555.48,"setting":"both","billing_class":"facility"}]},{"description":"Permethrin 1% 60mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517575","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122010846","type":"NDC"}],"standard_charges":[{"gross_charge":32.16,"setting":"both","billing_class":"facility"}]},{"description":"Trilafon","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2517615","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"68084060201","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"setting":"both","billing_class":"facility"}]},{"description":"Dilantin","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2517720","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862069201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"OMIDRIA 1-0.3% VIAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2517740","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1097","type":"HCPCS"},{"code":"82604060004","type":"NDC"}],"standard_charges":[{"gross_charge":2596.0,"setting":"both","billing_class":"facility"}]},{"description":"Neo-Synephrine 10% 0.5mL from 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517749","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":197.04,"setting":"both","billing_class":"facility"}]},{"description":"Neo-Synephrine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2517750","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080125","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML-NS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2517751","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71266901101","type":"NDC"}],"standard_charges":[{"gross_charge":33.18,"setting":"both","billing_class":"facility"}]},{"description":"Vazculep","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2517752","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080876","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"}]},{"description":"PHENobarbitaL sodium","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2517770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"14789012805","type":"NDC"}],"standard_charges":[{"gross_charge":227.60,"setting":"both","billing_class":"facility"}]},{"description":"Phenol 6% -- PAIN CLINIC ONLY","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2517780","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"71266650901","type":"NDC"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","billing_class":"facility"}]},{"description":"PHENobarbital Elixir","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2517870","type":"CDM"},{"code":"637","type":"RC"},{"code":"16571067516","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"PHENobarbitaL","drug_information":{"unit":"32.4","type":"UN"},"code_information":[{"code":"2517929","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904657561","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Dilantin Suspension","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2517943","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687027566","type":"NDC"}],"standard_charges":[{"gross_charge":27.11,"setting":"both","billing_class":"facility"}]},{"description":"Dilantin","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2517945","type":"CDM"},{"code":"637","type":"RC"},{"code":"00071374066","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"setting":"both","billing_class":"facility"}]},{"description":"Regitine 5mg/2mL Vial","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2517960","type":"CDM"},{"code":"637","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"gross_charge":2073.88,"setting":"both","billing_class":"facility"}]},{"description":"Pyridium","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2517991","type":"CDM"},{"code":"637","type":"RC"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"setting":"both","billing_class":"facility"}]},{"description":"Antilirium","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2518080","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"gross_charge":563.64,"setting":"both","billing_class":"facility"}]},{"description":"Aqua Mephyton","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2518120","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":256.62,"setting":"both","billing_class":"facility"}]},{"description":"Mephyton","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2518125","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710101403","type":"NDC"}],"standard_charges":[{"gross_charge":131.62,"setting":"both","billing_class":"facility"}]},{"description":"Aqua Mephyton Neonatal","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2518130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"00409915750","type":"NDC"}],"standard_charges":[{"gross_charge":25.86,"setting":"both","billing_class":"facility"}]},{"description":"Pilocarpine 1% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2518140","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":248.4,"setting":"both","billing_class":"facility"}]},{"description":"Pilocarpine 2% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2518150","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"gross_charge":360.54,"setting":"both","billing_class":"facility"}]},{"description":"Pilocarpine 4% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2518170","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069020101","type":"NDC"}],"standard_charges":[{"gross_charge":380.58,"setting":"both","billing_class":"facility"}]},{"description":"Actos","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2518367","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687039101","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"setting":"both","billing_class":"facility"}]},{"description":"Prevnar 13","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2518394","type":"CDM"},{"code":"636","type":"RC"},{"code":"90670","type":"HCPCS"},{"code":"00005197102","type":"NDC"}],"standard_charges":[{"gross_charge":2708.16,"setting":"both","billing_class":"facility"}]},{"description":"PREVNAR 20 SYRINGE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2518395","type":"CDM"},{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":3107.06,"setting":"both","billing_class":"facility"}]},{"description":"Zosyn","drug_information":{"unit":"3.375","type":"UN"},"code_information":[{"code":"2518397","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311390","type":"NDC"}],"standard_charges":[{"gross_charge":16.67,"setting":"both","billing_class":"facility"}]},{"description":"Zosyn","drug_information":{"unit":"2.25","type":"UN"},"code_information":[{"code":"2518401","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"setting":"both","billing_class":"facility"}]},{"description":"Zosyn","drug_information":{"unit":"4.5","type":"UN"},"code_information":[{"code":"2518402","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311491","type":"NDC"}],"standard_charges":[{"gross_charge":165.3,"setting":"both","billing_class":"facility"}]},{"description":"Plavix","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2518421","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084053601","type":"NDC"}],"standard_charges":[{"gross_charge":40.86,"setting":"both","billing_class":"facility"}]},{"description":"Pneumovax 23","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2518440","type":"CDM"},{"code":"636","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"00006494300","type":"NDC"}],"standard_charges":[{"gross_charge":1404.96,"setting":"both","billing_class":"facility"}]},{"description":"Polio Vaccine Injection","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2518491","type":"CDM"},{"code":"636","type":"RC"},{"code":"90713","type":"HCPCS"},{"code":"49281086010","type":"NDC"}],"standard_charges":[{"gross_charge":4838.02,"setting":"both","billing_class":"facility"}]},{"description":"Polivy","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2518550","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"50242010301","type":"NDC"}],"standard_charges":[{"gross_charge":19940.85,"setting":"both","billing_class":"facility"}]},{"description":"Polivy","drug_information":{"unit":"140","type":"ME"},"code_information":[{"code":"2518551","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":83751.34,"setting":"both","billing_class":"facility"}]},{"description":"Miralax 238 GM Bottle","drug_information":{"unit":"238","type":"GM"},"code_information":[{"code":"2518563","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001050555","type":"NDC"}],"standard_charges":[{"gross_charge":56.1,"setting":"both","billing_class":"facility"}]},{"description":"Miralax 17 GM Packet","drug_information":{"unit":"17","type":"UN"},"code_information":[{"code":"2518564","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559015710","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"setting":"both","billing_class":"facility"}]},{"description":"Cortisporin Otic Sus 10mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2518595","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":270.42,"setting":"both","billing_class":"facility"}]},{"description":"Polytrim 200drops/10mL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2518596","type":"CDM"},{"code":"637","type":"RC"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":104.52,"setting":"both","billing_class":"facility"}]},{"description":"Micro-K","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2518720","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687046601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Potassium Chloride","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2518721","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687081009","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Potassium Acetate","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2518765","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754200104","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"setting":"both","billing_class":"facility"}]},{"description":"Kay Ciel","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2518780","type":"CDM"},{"code":"637","type":"RC"},{"code":"66689004750","type":"NDC"}],"standard_charges":[{"gross_charge":111.6,"setting":"both","billing_class":"facility"}]},{"description":"K-Lyte","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2518800","type":"CDM"},{"code":"637","type":"RC"},{"code":"00245532630","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"setting":"both","billing_class":"facility"}]},{"description":"Potassium Chloride","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2518810","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 10 MEQ/100 ML SOL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2518811","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":23.7,"setting":"both","billing_class":"facility"}]},{"description":"Lugols","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2518839","type":"CDM"},{"code":"637","type":"RC"},{"code":"00395277516","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Potassium Phosphate","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2518840","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409729501","type":"NDC"}],"standard_charges":[{"gross_charge":72.98,"setting":"both","billing_class":"facility"}]},{"description":"Betadine Oint 1oz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519030","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536127180","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"setting":"both","billing_class":"facility"}]},{"description":"Folotyn","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2519066","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9307","type":"HCPCS"},{"code":"48818000101","type":"NDC"}],"standard_charges":[{"gross_charge":30543.84,"setting":"both","billing_class":"facility"}]},{"description":"APLISOL test from 50test vial","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"2519070","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"setting":"both","billing_class":"facility"}]},{"description":"Mirapex","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2519074","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687057001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Mirapex","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519075","type":"CDM"},{"code":"637","type":"RC"},{"code":"13668009490","type":"NDC"}],"standard_charges":[{"gross_charge":17.7,"setting":"both","billing_class":"facility"}]},{"description":"Procto Foam HC 10GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519083","type":"CDM"},{"code":"250","type":"RC"},{"code":"00037682410","type":"NDC"}],"standard_charges":[{"gross_charge":529.8,"setting":"both","billing_class":"facility"}]},{"description":"predniSONE","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2519120","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054001720","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Orapred","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2519129","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"17856075905","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"setting":"both","billing_class":"facility"}]},{"description":"Deltasone","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2519170","type":"CDM"},{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"PRED FORTE 1%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2519172","type":"CDM"},{"code":"637","type":"RC"},{"code":"60758011910","type":"NDC"}],"standard_charges":[{"gross_charge":317.64,"setting":"both","billing_class":"facility"}]},{"description":"predniSONE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519234","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60219170501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Deltasone 120ML BOTTLE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2519235","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054372250","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"predniSONE","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2519250","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054872425","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lyrica","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2519281","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687051701","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"setting":"both","billing_class":"facility"}]},{"description":"Lyrica","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2519282","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687049501","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"setting":"both","billing_class":"facility"}]},{"description":"Lyrica","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2519283","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687048401","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"setting":"both","billing_class":"facility"}]},{"description":"Lyrica","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2519284","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687047301","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"setting":"both","billing_class":"facility"}]},{"description":"Mysoline","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2519390","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084020301","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"setting":"both","billing_class":"facility"}]},{"description":"Mysoline","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2519401","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"setting":"both","billing_class":"facility"}]},{"description":"Benemid","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2519410","type":"CDM"},{"code":"637","type":"RC"},{"code":"00591534701","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"setting":"both","billing_class":"facility"}]},{"description":"PROCAINAMIDE HCL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2519420","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"76329339905","type":"NDC"}],"standard_charges":[{"gross_charge":299.88,"setting":"both","billing_class":"facility"}]},{"description":"Compazine","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2519450","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268068515","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"setting":"both","billing_class":"facility"}]},{"description":"Compazine Supp","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2519500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"gross_charge":75.48,"setting":"both","billing_class":"facility"}]},{"description":"Compazine","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2519600","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"50268068415","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"setting":"both","billing_class":"facility"}]},{"description":"Phenergan Supp","drug_information":{"unit":"12.5","type":"UN"},"code_information":[{"code":"2519640","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713053612","type":"NDC"}],"standard_charges":[{"gross_charge":106.26,"setting":"both","billing_class":"facility"}]},{"description":"Phenergan","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2519690","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084015501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Prochlorperazine Edisylate","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2519700","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70860077802","type":"NDC"}],"standard_charges":[{"gross_charge":38.1,"setting":"both","billing_class":"facility"}]},{"description":"Phenergan Supp","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2519720","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713013212","type":"NDC"}],"standard_charges":[{"gross_charge":214.62,"setting":"both","billing_class":"facility"}]},{"description":"Phenergan Exp.","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2519740","type":"CDM"},{"code":"637","type":"RC"},{"code":"17856060805","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"setting":"both","billing_class":"facility"}]},{"description":"Rythmol","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2519756","type":"CDM"},{"code":"637","type":"RC"},{"code":"62559023001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Inderal","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2519760","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904655061","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"PROPRANOLOL HCL","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2519761","type":"CDM"},{"code":"637","type":"RC"},{"code":"69238208101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Inderal LA","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2519764","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687021501","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"setting":"both","billing_class":"facility"}]},{"description":"Inderal LA","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2519765","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687022601","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"setting":"both","billing_class":"facility"}]},{"description":"Alcaine 0.5% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519780","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":196.98,"setting":"both","billing_class":"facility"}]},{"description":"Alcaine 0.5% 0.5mL from 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2519781","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478026312","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"setting":"both","billing_class":"facility"}]},{"description":"Inderal","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2519810","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"gross_charge":13.34,"setting":"both","billing_class":"facility"}]},{"description":"Diprivan","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2519842","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"setting":"both","billing_class":"facility"}]},{"description":"Diprivan","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2519844","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469924","type":"NDC"}],"standard_charges":[{"gross_charge":129.54,"setting":"both","billing_class":"facility"}]},{"description":"PROPRANOLOL HCL","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2519865","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687059801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Inderal LA","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2519868","type":"CDM"},{"code":"637","type":"RC"},{"code":"51991081901","type":"NDC"}],"standard_charges":[{"gross_charge":17.88,"setting":"both","billing_class":"facility"}]},{"description":"PROPRANOLOL HCL","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2519890","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687060901","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Kcentra","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2519891","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7168","type":"HCPCS"},{"code":"63833038602","type":"NDC"}],"standard_charges":[{"gross_charge":5967.75,"setting":"both","billing_class":"facility"}]},{"description":"Altuviiio","drug_information":{"unit":"4000","type":"UN"},"code_information":[{"code":"2519895","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7214","type":"HCPCS"},{"code":"71104098401","type":"NDC"}],"standard_charges":[{"gross_charge":100976.22,"setting":"both","billing_class":"facility"}]},{"description":"Altuviiio","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2519896","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7214","type":"HCPCS"},{"code":"71104097901","type":"NDC"}],"standard_charges":[{"gross_charge":13807.5,"setting":"both","billing_class":"facility"}]},{"description":"ALTUVIIIO","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2519897","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7214","type":"HCPCS"},{"code":"71104098201","type":"NDC"}],"standard_charges":[{"gross_charge":46274.85,"setting":"both","billing_class":"facility"}]},{"description":"ALTUVIIIO","drug_information":{"unit":"3000","type":"UN"},"code_information":[{"code":"2519898","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7214","type":"HCPCS"},{"code":"71104098301","type":"NDC"}],"standard_charges":[{"gross_charge":72524.88,"setting":"both","billing_class":"facility"}]},{"description":"ALTUVIIIO","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2519899","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7214","type":"HCPCS"},{"code":"71104098101","type":"NDC"}],"standard_charges":[{"gross_charge":22533.84,"setting":"both","billing_class":"facility"}]},{"description":"Protamine Sulfate","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2519990","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":92.88,"setting":"both","billing_class":"facility"}]},{"description":"PYRAZINAMIDE","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2519991","type":"CDM"},{"code":"637","type":"RC"},{"code":"61748001206","type":"NDC"}],"standard_charges":[{"gross_charge":37.86,"setting":"both","billing_class":"facility"}]},{"description":"BANATROL PLUS POWDER PACKET","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2519999","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688008470","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"setting":"both","billing_class":"facility"}]},{"description":"Prozac","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2520013","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904578461","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sudafed","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2520040","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904633724","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Metamucil","drug_information":{"unit":"3.4","type":"UN"},"code_information":[{"code":"2520100","type":"CDM"},{"code":"637","type":"RC"},{"code":"37000002304","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin B6 Vial","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2520130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":130.38,"setting":"both","billing_class":"facility"}]},{"description":"Mestinon","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2520151","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687050201","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"setting":"both","billing_class":"facility"}]},{"description":"Pyridoxine","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2520170","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268085815","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SEROquel","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2520215","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001018000","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SEROquel","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2520217","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268063315","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Seroquel XR","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2520219","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729013212","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Seroquel XR","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2520221","type":"CDM"},{"code":"637","type":"RC"},{"code":"16729010912","type":"NDC"}],"standard_charges":[{"gross_charge":95.52,"setting":"both","billing_class":"facility"}]},{"description":"Seroquel XR","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2520222","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001060006","type":"NDC"}],"standard_charges":[{"gross_charge":105.18,"setting":"both","billing_class":"facility"}]},{"description":"SEROquel","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2520223","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268063215","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Accupril","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2520227","type":"CDM"},{"code":"637","type":"RC"},{"code":"62135048590","type":"NDC"}],"standard_charges":[{"gross_charge":26.95,"setting":"both","billing_class":"facility"}]},{"description":"Rabies Immune Globulin (Human)","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2520286","type":"CDM"},{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":7280.68,"setting":"both","billing_class":"facility"}]},{"description":"Imovax","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520290","type":"CDM"},{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281025251","type":"NDC"}],"standard_charges":[{"gross_charge":4962.76,"setting":"both","billing_class":"facility"}]},{"description":"Evista","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2520293","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862070930","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ISENTRESS","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2520294","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"00006022761","type":"NDC"}],"standard_charges":[{"gross_charge":192.69,"setting":"both","billing_class":"facility"}]},{"description":"Altace","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2520296","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001043000","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"setting":"both","billing_class":"facility"}]},{"description":"Altace","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2520297","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001042900","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"setting":"both","billing_class":"facility"}]},{"description":"Cyramza","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520311","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":7283.95,"setting":"both","billing_class":"facility"}]},{"description":"Cyramza","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2520313","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":33105.56,"setting":"both","billing_class":"facility"}]},{"description":"Ranexa","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2520315","type":"CDM"},{"code":"637","type":"RC"},{"code":"27241012502","type":"NDC"}],"standard_charges":[{"gross_charge":40.44,"setting":"both","billing_class":"facility"}]},{"description":"Elitek","drug_information":{"unit":"1.5","type":"UN"},"code_information":[{"code":"2520319","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"00024515010","type":"NDC"}],"standard_charges":[{"gross_charge":5453.15,"setting":"both","billing_class":"facility"}]},{"description":"Elitek","drug_information":{"unit":"7.5","type":"UN"},"code_information":[{"code":"2520323","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"00024515175","type":"NDC"}],"standard_charges":[{"gross_charge":24539.22,"setting":"both","billing_class":"facility"}]},{"description":"ULTOMIRIS","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2520326","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":29394.36,"setting":"both","billing_class":"facility"}]},{"description":"ULTOMIRIS","drug_information":{"unit":"11","type":"ML"},"code_information":[{"code":"2520327","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002801","type":"NDC"}],"standard_charges":[{"gross_charge":107779.32,"setting":"both","billing_class":"facility"}]},{"description":"Lexiscan","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2520328","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":78.9,"setting":"both","billing_class":"facility"}]},{"description":"R.E.C.K.(ROPIV-EPI-CLON-KETOR)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2520329","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":370.2,"setting":"both","billing_class":"facility"}]},{"description":"REMDESIVIR (EUA)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2520330","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":3297.14,"setting":"both","billing_class":"facility"}]},{"description":"Cinqair","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520331","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2786","type":"HCPCS"},{"code":"59310061031","type":"NDC"}],"standard_charges":[{"gross_charge":5460.0,"setting":"both","billing_class":"facility"}]},{"description":"rifAMPin","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2520340","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"gross_charge":992.1,"setting":"both","billing_class":"facility"}]},{"description":"XIFAXAN","drug_information":{"unit":"550","type":"UN"},"code_information":[{"code":"2520341","type":"CDM"},{"code":"637","type":"RC"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":326.7,"setting":"both","billing_class":"facility"}]},{"description":"SKYRIZI","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520350","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2327","type":"HCPCS"},{"code":"00074501501","type":"NDC"}],"standard_charges":[{"gross_charge":45043.47,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL Consta","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520358","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030811","type":"NDC"}],"standard_charges":[{"gross_charge":6146.05,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL Consta","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520359","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030911","type":"NDC"}],"standard_charges":[{"gross_charge":1690.20,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL Consta","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520361","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030711","type":"NDC"}],"standard_charges":[{"gross_charge":5070.34,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL Consta","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520362","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030611","type":"NDC"}],"standard_charges":[{"gross_charge":3380.08,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL M","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520363","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746003022","type":"NDC"}],"standard_charges":[{"gross_charge":53.7,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL M","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520364","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746002022","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL M","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2520365","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746001032","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520367","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904636061","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"rifAMPin","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2520369","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520372","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904635961","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2520374","type":"CDM"},{"code":"637","type":"RC"},{"code":"27808000201","type":"NDC"}],"standard_charges":[{"gross_charge":80.88,"setting":"both","billing_class":"facility"}]},{"description":"RisperDAL","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2520377","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084027001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Rituxan","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2520378","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":23488.0,"setting":"both","billing_class":"facility"}]},{"description":"TRUXIMA","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520379","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":4487.78,"setting":"both","billing_class":"facility"}]},{"description":"TRUXIMA","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2520380","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":20398.9,"setting":"both","billing_class":"facility"}]},{"description":"Exelon","drug_information":{"unit":"4.6","type":"UN"},"code_information":[{"code":"2520381","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378907093","type":"NDC"}],"standard_charges":[{"gross_charge":101.4,"setting":"both","billing_class":"facility"}]},{"description":"Exelon","drug_information":{"unit":"1.5","type":"UN"},"code_information":[{"code":"2520382","type":"CDM"},{"code":"637","type":"RC"},{"code":"72241001103","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Exelon","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2520383","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332006460","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Exelon","drug_information":{"unit":"9.5","type":"UN"},"code_information":[{"code":"2520385","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378907193","type":"NDC"}],"standard_charges":[{"gross_charge":101.4,"setting":"both","billing_class":"facility"}]},{"description":"XARELTO","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2520386","type":"CDM"},{"code":"637","type":"RC"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"gross_charge":56.94,"setting":"both","billing_class":"facility"}]},{"description":"Xarelto","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2520387","type":"CDM"},{"code":"637","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"gross_charge":113.94,"setting":"both","billing_class":"facility"}]},{"description":"Xarelto","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2520388","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057810","type":"NDC"}],"standard_charges":[{"gross_charge":113.94,"setting":"both","billing_class":"facility"}]},{"description":"Xarelto","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2520389","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":113.94,"setting":"both","billing_class":"facility"}]},{"description":"Rituxan","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520391","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":5167.36,"setting":"both","billing_class":"facility"}]},{"description":"Rituxan Hycela","drug_information":{"unit":"11.7","type":"ML"},"code_information":[{"code":"2520393","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801","type":"NDC"}],"standard_charges":[{"gross_charge":29594.61,"setting":"both","billing_class":"facility"}]},{"description":"Rituxan Hycela","drug_information":{"unit":"13.4","type":"ML"},"code_information":[{"code":"2520394","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010901","type":"NDC"}],"standard_charges":[{"gross_charge":33822.40,"setting":"both","billing_class":"facility"}]},{"description":"RUXIENCE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520395","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801","type":"NDC"}],"standard_charges":[{"gross_charge":3378.38,"setting":"both","billing_class":"facility"}]},{"description":"RUXIENCE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2520396","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":15356.0,"setting":"both","billing_class":"facility"}]},{"description":"Rocephin","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2520416","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":161.1,"setting":"both","billing_class":"facility"}]},{"description":"Zemuron","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2520421","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266200201","type":"NDC"}],"standard_charges":[{"gross_charge":51.6,"setting":"both","billing_class":"facility"}]},{"description":"Daliresp","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2520425","type":"CDM"},{"code":"252","type":"RC"},{"code":"68382096906","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ISTODAX","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2520430","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9319","type":"HCPCS"},{"code":"59572098401","type":"NDC"}],"standard_charges":[{"gross_charge":15993.25,"setting":"both","billing_class":"facility"}]},{"description":"NPLATE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2520440","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":6883.45,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 125 MCG"}]},{"description":"NPlate","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2520441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":13765.1,"setting":"both","billing_class":"facility"}]},{"description":"LEQVIO","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2520443","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":17248.7,"setting":"both","billing_class":"facility"}]},{"description":"EVENITY (2 SYRINGES)","drug_information":{"unit":"2.34","type":"ML"},"code_information":[{"code":"2520444","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":13144.6,"setting":"both","billing_class":"facility"}]},{"description":"Naropin 20mL 1%","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2520446","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028821","type":"NDC"}],"standard_charges":[{"gross_charge":136.2,"setting":"both","billing_class":"facility"}]},{"description":"Naropin 0.2%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520453","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028513","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"setting":"both","billing_class":"facility"}]},{"description":"Requip","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"2520454","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687057701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Requip","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2520456","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332003131","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"}]},{"description":"Requip","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2520457","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332003331","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"}]},{"description":"Naropin 0.5%","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2520459","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"gross_charge":42.06,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 0.5% 150 MG/30 ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2520460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002301","type":"NDC"}],"standard_charges":[{"gross_charge":27.50,"setting":"both","billing_class":"facility"}]},{"description":"ENTRESTO 24 MG-26 MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2520461","type":"CDM"},{"code":"252","type":"RC"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"gross_charge":68.82,"setting":"both","billing_class":"facility"}]},{"description":"Trodelvy","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2520462","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9317","type":"HCPCS"},{"code":"55135013201","type":"NDC"}],"standard_charges":[{"gross_charge":12566.2,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride Irrigation","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2520491","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4217","type":"HCPCS"},{"code":"00338004803","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Deep Sea Nasal 44mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520494","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zoloft","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2520499","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862001305","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"setting":"both","billing_class":"facility"}]},{"description":"Transderm Scop","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520530","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058062","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"setting":"both","billing_class":"facility"}]},{"description":"COSENTYX","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2520650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":10787.55,"setting":"both","billing_class":"facility"}]},{"description":"Senokot","drug_information":{"unit":"8.6","type":"UN"},"code_information":[{"code":"2520680","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904725261","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Senokot S","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520685","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zoloft","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2520691","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SEROquel","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2520692","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268063015","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Ultane","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2520693","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781616086","type":"NDC"}],"standard_charges":[{"gross_charge":967.5,"setting":"both","billing_class":"facility"}]},{"description":"Silvadene 400 GM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520695","type":"CDM"},{"code":"250","type":"RC"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"facility"}]},{"description":"Silvadene 25GM TUBE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520696","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":41.4,"setting":"both","billing_class":"facility"}]},{"description":"Silver Nitrate","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520697","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Renvela","drug_information":{"unit":"800","type":"UN"},"code_information":[{"code":"2520698","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268072015","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Simethicone Drops 30mL","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2520710","type":"CDM"},{"code":"637","type":"RC"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"setting":"both","billing_class":"facility"}]},{"description":"Kinevac","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2520777","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"00270055615","type":"NDC"}],"standard_charges":[{"gross_charge":758.51,"setting":"both","billing_class":"facility"}]},{"description":"Sinemet 25-100","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520780","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sinemet 25-250","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520790","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084009401","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"setting":"both","billing_class":"facility"}]},{"description":"Provenge","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2520801","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2043","type":"HCPCS"},{"code":"30237890006","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Januvia","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2520805","type":"CDM"},{"code":"637","type":"RC"},{"code":"00006011228","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.45%","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2520880","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride Irrigation","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2520890","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4217","type":"HCPCS"},{"code":"00338004804","type":"NDC"}],"standard_charges":[{"gross_charge":27.48,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520891","type":"CDM"},{"code":"637","type":"RC"},{"code":"00223176001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2520900","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Acetate","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2520910","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00409729973","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Bicarb Ped 4.2%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520920","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409553414","type":"NDC"}],"standard_charges":[{"gross_charge":120.66,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% PF","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2520930","type":"CDM"},{"code":"270","type":"RC"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"setting":"both","billing_class":"facility"}]},{"description":"Muro-128 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520935","type":"CDM"},{"code":"637","type":"RC"},{"code":"24208027615","type":"NDC"}],"standard_charges":[{"gross_charge":100.2,"setting":"both","billing_class":"facility"}]},{"description":"Bleph 10 10mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2520960","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":110.82,"setting":"both","billing_class":"facility"}]},{"description":"Kayexalate","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2520980","type":"CDM"},{"code":"637","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":186.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2521030","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"00338004902","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% Excel","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2521032","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"00264780020","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride Bacteriostatic","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2521060","type":"CDM"},{"code":"270","type":"RC"},{"code":"00409196607","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Phosphate","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2521070","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409739172","type":"NDC"}],"standard_charges":[{"gross_charge":109.68,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.45%","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2521120","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.9% EXCEL","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2521123","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"65219047220","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2521124","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990798420","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% Excel","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2521125","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 3%","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2521127","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2521128","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"00338004904","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2521129","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% Sterile Flush","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521132","type":"CDM"},{"code":"250","type":"RC"},{"code":"08290306553","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% Flush","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521135","type":"CDM"},{"code":"270","type":"RC"},{"code":"08290306547","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% Mini-Bag Plus","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2521141","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% 100mL Mini-Bag Plus","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2521142","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2521150","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% KCl 20mEq","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2521155","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711509","type":"NDC"}],"standard_charges":[{"gross_charge":41.16,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 0.9% KCl 40mEq 1000mL","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2521156","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":82.98,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride 23.4%","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2521170","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":40.26,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride Irrigation","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2521171","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004746","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Chloride Irrigation","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"2521172","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004747","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Bicarbonate 8.4%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2521180","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409663714","type":"NDC"}],"standard_charges":[{"gross_charge":115.08,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Bicarbonate","drug_information":{"unit":"650","type":"UN"},"code_information":[{"code":"2521185","type":"CDM"},{"code":"637","type":"RC"},{"code":"77333082710","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Bicarbonate 8.4%","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2521190","type":"CDM"},{"code":"250","type":"RC"},{"code":"81298762001","type":"NDC"}],"standard_charges":[{"gross_charge":30.56,"setting":"both","billing_class":"facility"}]},{"description":"Sodium Thiosulfate","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2521251","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":720.0,"setting":"both","billing_class":"facility"}]},{"description":"Sorbitol 70%","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"2521280","type":"CDM"},{"code":"637","type":"RC"},{"code":"46287050001","type":"NDC"}],"standard_charges":[{"gross_charge":91.56,"setting":"both","billing_class":"facility"}]},{"description":"Betapace","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2521285","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084065401","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB (EUA)","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"2521290","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0247","type":"HCPCS"},{"code":"00173090186","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Aldactone","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2521310","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"STERILE WATER FOR INJ","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2521320","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"00338001304","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"STERILE WATER FOR INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521330","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488710","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"setting":"both","billing_class":"facility"}]},{"description":"Sterile Water Bacteriostatic","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2521335","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409397703","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"setting":"both","billing_class":"facility"}]},{"description":"STERILE WATER FOR IRRIG","drug_information":{"unit":"1500","type":"ML"},"code_information":[{"code":"2521345","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338000405","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Quelicin","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521400","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071910","type":"NDC"}],"standard_charges":[{"gross_charge":116.22,"setting":"both","billing_class":"facility"}]},{"description":"SUCCINYLCHOLINE CHLORIDE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521406","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266200102","type":"NDC"}],"standard_charges":[{"gross_charge":109.56,"setting":"both","billing_class":"facility"}]},{"description":"Carafate","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2521420","type":"CDM"},{"code":"637","type":"RC"},{"code":"51079075320","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Carafate","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2521423","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268074514","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"setting":"both","billing_class":"facility"}]},{"description":"BRIDION","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2521530","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"gross_charge":777.96,"setting":"both","billing_class":"facility"}]},{"description":"Bridion","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2521531","type":"CDM"},{"code":"252","type":"RC"},{"code":"00006542515","type":"NDC"}],"standard_charges":[{"gross_charge":1425.0,"setting":"both","billing_class":"facility"}]},{"description":"Azulfidine EC","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2521545","type":"CDM"},{"code":"637","type":"RC"},{"code":"00093323401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Lumason 60.7-25mg","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2521551","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9950","type":"HCPCS"},{"code":"00270709916","type":"NDC"}],"standard_charges":[{"gross_charge":507.3,"setting":"both","billing_class":"facility"}]},{"description":"Imitrex","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2521585","type":"CDM"},{"code":"637","type":"RC"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Imitrex","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2521586","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452034672","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Synvisc","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2521601","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009001","type":"NDC"}],"standard_charges":[{"gross_charge":2510.97,"setting":"both","billing_class":"facility"}]},{"description":"Supartz FX","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2521602","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89130444401","type":"NDC"}],"standard_charges":[{"gross_charge":1423.26,"setting":"both","billing_class":"facility"}]},{"description":"HYALGAN 20MG/2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2521603","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89122072420","type":"NDC"}],"standard_charges":[{"gross_charge":1055.64,"setting":"both","billing_class":"facility"}]},{"description":"Prograf","drug_information":{"unit":"0.5","type":"UN"},"code_information":[{"code":"2521721","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084044901","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"setting":"both","billing_class":"facility"}]},{"description":"Nolvadex","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2521730","type":"CDM"},{"code":"637","type":"RC"},{"code":"51862064260","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"setting":"both","billing_class":"facility"}]},{"description":"Imlygic","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2521739","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9325","type":"HCPCS"},{"code":"55513007901","type":"NDC"}],"standard_charges":[{"gross_charge":31436.06,"setting":"both","billing_class":"facility"}]},{"description":"GRANIX","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2521740","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":2122.45,"setting":"both","billing_class":"facility"}]},{"description":"Micardis","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2521742","type":"CDM"},{"code":"637","type":"RC"},{"code":"68382047278","type":"NDC"}],"standard_charges":[{"gross_charge":32.94,"setting":"both","billing_class":"facility"}]},{"description":"Micardis","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2521743","type":"CDM"},{"code":"637","type":"RC"},{"code":"68382047378","type":"NDC"}],"standard_charges":[{"gross_charge":32.94,"setting":"both","billing_class":"facility"}]},{"description":"TNKase","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2521747","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":35470.8,"setting":"both","billing_class":"facility"}]},{"description":"Restoril","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"2521752","type":"CDM"},{"code":"637","type":"RC"},{"code":"67877014601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Restoril","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2521753","type":"CDM"},{"code":"637","type":"RC"},{"code":"67877014701","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"setting":"both","billing_class":"facility"}]},{"description":"Restoril","drug_information":{"unit":"7.5","type":"UN"},"code_information":[{"code":"2521756","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084054921","type":"NDC"}],"standard_charges":[{"gross_charge":50.1,"setting":"both","billing_class":"facility"}]},{"description":"Hytrin","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2521757","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746038506","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"setting":"both","billing_class":"facility"}]},{"description":"TEPEZZA","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2521758","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3241","type":"HCPCS"},{"code":"75987013015","type":"NDC"}],"standard_charges":[{"gross_charge":78800.08,"setting":"both","billing_class":"facility"}]},{"description":"Brethine","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2521760","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"setting":"both","billing_class":"facility"}]},{"description":"Lamisil 1% 15gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2521761","type":"CDM"},{"code":"637","type":"RC"},{"code":"51672208001","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"setting":"both","billing_class":"facility"}]},{"description":"Brethine","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2521770","type":"CDM"},{"code":"637","type":"RC"},{"code":"24979013201","type":"NDC"}],"standard_charges":[{"gross_charge":32.64,"setting":"both","billing_class":"facility"}]},{"description":"Depo-Testosterone","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2521861","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00009041701","type":"NDC"}],"standard_charges":[{"gross_charge":142.74,"setting":"both","billing_class":"facility"}]},{"description":"Tenivac","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2521930","type":"CDM"},{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":465.72,"setting":"both","billing_class":"facility"}]},{"description":"Hypertet 250 Unit Syringe","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"2521940","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1670","type":"HCPCS"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"gross_charge":2958.34,"setting":"both","billing_class":"facility"}]},{"description":"TETRACAINE 0.5% STERI-UNIT SOL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2522044","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":75.36,"setting":"both","billing_class":"facility"}]},{"description":"Theodur","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2522170","type":"CDM"},{"code":"637","type":"RC"},{"code":"68462072101","type":"NDC"}],"standard_charges":[{"gross_charge":25.8,"setting":"both","billing_class":"facility"}]},{"description":"Uniphyl","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2522185","type":"CDM"},{"code":"637","type":"RC"},{"code":"68462038001","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"setting":"both","billing_class":"facility"}]},{"description":"Theo-24 100mg Cap 24 Hour","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2522197","type":"CDM"},{"code":"252","type":"RC"},{"code":"52244010010","type":"NDC"}],"standard_charges":[{"gross_charge":21.12,"setting":"both","billing_class":"facility"}]},{"description":"Thrombinar","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"2522560","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793021505","type":"NDC"}],"standard_charges":[{"gross_charge":378.84,"setting":"both","billing_class":"facility"}]},{"description":"Armour Thyroid","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"2522600","type":"CDM"},{"code":"637","type":"RC"},{"code":"42192032901","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"setting":"both","billing_class":"facility"}]},{"description":"Armour Thyroid","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"2522610","type":"CDM"},{"code":"637","type":"RC"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"setting":"both","billing_class":"facility"}]},{"description":"THYROGEN","drug_information":{"unit":"0.9","type":"UN"},"code_information":[{"code":"2522612","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3240","type":"HCPCS"},{"code":"58468003002","type":"NDC"}],"standard_charges":[{"gross_charge":21232.3,"setting":"both","billing_class":"facility"}]},{"description":"Timoptic 0.25% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522670","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"gross_charge":61.44,"setting":"both","billing_class":"facility"}]},{"description":"Timoptic 0.5% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522680","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":48.54,"setting":"both","billing_class":"facility"}]},{"description":"Timoptic 0.5% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522681","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022715","type":"NDC"}],"standard_charges":[{"gross_charge":81.18,"setting":"both","billing_class":"facility"}]},{"description":"AGGRASTAT 12.5 MG/250 ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2522701","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"25208000202","type":"NDC"}],"standard_charges":[{"gross_charge":1434.0,"setting":"both","billing_class":"facility"}]},{"description":"Zanaflex","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2522706","type":"CDM"},{"code":"637","type":"RC"},{"code":"55111017915","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"setting":"both","billing_class":"facility"}]},{"description":"Zanaflex","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2522707","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084064501","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"setting":"both","billing_class":"facility"}]},{"description":"Tobrex Ophth 0.3% 3.5 gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522740","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078081301","type":"NDC"}],"standard_charges":[{"gross_charge":1415.58,"setting":"both","billing_class":"facility"}]},{"description":"Nebcin","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2522750","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":14.28,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN 300 MG/5 ML AMPULE","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2522751","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7682","type":"HCPCS"},{"code":"60687073183","type":"NDC"}],"standard_charges":[{"gross_charge":129.6,"setting":"both","billing_class":"facility"}]},{"description":"Tobrex Ophth 0.3% 5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522760","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":33.48,"setting":"both","billing_class":"facility"}]},{"description":"Tobradex 2.5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522765","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":282.54,"setting":"both","billing_class":"facility"}]},{"description":"Actemra","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2522770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":12814.35,"setting":"both","billing_class":"facility"}]},{"description":"Actemra","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2522771","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":2819.14,"setting":"both","billing_class":"facility"}]},{"description":"Actemra","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2522773","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":6407.2,"setting":"both","billing_class":"facility"}]},{"description":"Detrol","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2522800","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093001806","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"setting":"both","billing_class":"facility"}]},{"description":"Topamax","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"2522845","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"setting":"both","billing_class":"facility"}]},{"description":"Topamax","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2522846","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084034401","type":"NDC"}],"standard_charges":[{"gross_charge":37.2,"setting":"both","billing_class":"facility"}]},{"description":"Hycamtin","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2522851","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"16729015131","type":"NDC"}],"standard_charges":[{"gross_charge":777.6,"setting":"both","billing_class":"facility"}]},{"description":"Demadex","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2522865","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Demadex","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2522867","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084053901","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"setting":"both","billing_class":"facility"}]},{"description":"Yondelis","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2522870","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9352","type":"HCPCS"},{"code":"59676061001","type":"NDC"}],"standard_charges":[{"gross_charge":18446.7,"setting":"both","billing_class":"facility"}]},{"description":"TRALEMENT VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2522881","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517930525","type":"NDC"}],"standard_charges":[{"gross_charge":154.92,"setting":"both","billing_class":"facility"}]},{"description":"Ultram","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2522885","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tranexamic Acid","drug_information":{"unit":"650","type":"UN"},"code_information":[{"code":"2522888","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591372030","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"setting":"both","billing_class":"facility"}]},{"description":"Tranexamic Acid","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2522889","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150018810","type":"NDC"}],"standard_charges":[{"gross_charge":17.23,"setting":"both","billing_class":"facility"}]},{"description":"OGIVRI","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2522890","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257000111","type":"NDC"}],"standard_charges":[{"gross_charge":5172.80,"setting":"both","billing_class":"facility"}]},{"description":"Herceptin","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2522892","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242013201","type":"NDC"}],"standard_charges":[{"gross_charge":7792.1,"setting":"both","billing_class":"facility"}]},{"description":"HERCEPTIN HYLECTA 600MG-10,000","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2522894","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9356","type":"HCPCS"},{"code":"50242007701","type":"NDC"}],"standard_charges":[{"gross_charge":23376.2,"setting":"both","billing_class":"facility"}]},{"description":"Travatan Z 0.004% 2.5mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522896","type":"CDM"},{"code":"637","type":"RC"},{"code":"00378965132","type":"NDC"}],"standard_charges":[{"gross_charge":666.42,"setting":"both","billing_class":"facility"}]},{"description":"KANJINTI MDV","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2522897","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513013201","type":"NDC"}],"standard_charges":[{"gross_charge":1102.47,"setting":"both","billing_class":"facility"}]},{"description":"ENHERTU","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2522899","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9358","type":"HCPCS"},{"code":"65597040601","type":"NDC"}],"standard_charges":[{"gross_charge":14673.75,"setting":"both","billing_class":"facility"}]},{"description":"Desyrel","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2522900","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687045401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Desyrel","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2522910","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904686861","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Imjudo","drug_information":{"unit":"1.25","type":"ML"},"code_information":[{"code":"2522920","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"00310450525","type":"NDC"}],"standard_charges":[{"gross_charge":16908.0,"setting":"both","billing_class":"facility"}]},{"description":"Imjudo","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2522921","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Triamcinolone 0.1% 15gm Ointment","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522943","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"setting":"both","billing_class":"facility"}]},{"description":"Maxzide-50","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2522948","type":"CDM"},{"code":"637","type":"RC"},{"code":"68001032800","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"setting":"both","billing_class":"facility"}]},{"description":"Dyazide 37.5/25mg Capsule","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523060","type":"CDM"},{"code":"637","type":"RC"},{"code":"72578009001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Kenalog","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2523150","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104905","type":"NDC"}],"standard_charges":[{"gross_charge":61.2,"setting":"both","billing_class":"facility"}]},{"description":"Kenalog 0.1% 15 gm Cream","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523260","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"setting":"both","billing_class":"facility"}]},{"description":"Kenalog 0.025% 15 gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523261","type":"CDM"},{"code":"637","type":"RC"},{"code":"00168000315","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"setting":"both","billing_class":"facility"}]},{"description":"Kenalog 0.5% 15 gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523262","type":"CDM"},{"code":"637","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":48.78,"setting":"both","billing_class":"facility"}]},{"description":"Kenalog 0.1% 60 mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523263","type":"CDM"},{"code":"637","type":"RC"},{"code":"42571038519","type":"NDC"}],"standard_charges":[{"gross_charge":104.52,"setting":"both","billing_class":"facility"}]},{"description":"Stelazine","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2523380","type":"CDM"},{"code":"637","type":"RC"},{"code":"00781803401","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"setting":"both","billing_class":"facility"}]},{"description":"Artane","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2523400","type":"CDM"},{"code":"637","type":"RC"},{"code":"69452024120","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tigan","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2523430","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"gross_charge":316.32,"setting":"both","billing_class":"facility"}]},{"description":"Mydriacyl 1% 15 mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523579","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":36.3,"setting":"both","billing_class":"facility"}]},{"description":"Vision Blue 0.06%","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2523586","type":"CDM"},{"code":"250","type":"RC"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":576.72,"setting":"both","billing_class":"facility"}]},{"description":"Mydriacyl 1% 15mL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523610","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"setting":"both","billing_class":"facility"}]},{"description":"Incruse Ellipta 62.5mcg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2523816","type":"CDM"},{"code":"252","type":"RC"},{"code":"00173087306","type":"NDC"}],"standard_charges":[{"gross_charge":417.0,"setting":"both","billing_class":"facility"}]},{"description":"Actigall","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2523818","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687010001","type":"NDC"}],"standard_charges":[{"gross_charge":45.84,"setting":"both","billing_class":"facility"}]},{"description":"Stelara","drug_information":{"unit":"26","type":"ML"},"code_information":[{"code":"2523819","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":10598.3,"setting":"both","billing_class":"facility"}]},{"description":"Stelara","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2523821","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894006103","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Valtrex","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2523825","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084021501","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"setting":"both","billing_class":"facility"}]},{"description":"Depacon","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2523889","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143978510","type":"NDC"}],"standard_charges":[{"gross_charge":103.74,"setting":"both","billing_class":"facility"}]},{"description":"Valproic Acid","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2523891","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121467540","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"setting":"both","billing_class":"facility"}]},{"description":"Valstar","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2523899","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9357","type":"HCPCS"},{"code":"67979000101","type":"NDC"}],"standard_charges":[{"gross_charge":10279.2,"setting":"both","billing_class":"facility"}]},{"description":"Diovan","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2523908","type":"CDM"},{"code":"637","type":"RC"},{"code":"55111073290","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"setting":"both","billing_class":"facility"}]},{"description":"Diovan","drug_information":{"unit":"160","type":"UN"},"code_information":[{"code":"2523909","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687063401","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"setting":"both","billing_class":"facility"}]},{"description":"Vancomycin","drug_information":{"unit":"125","type":"UN"},"code_information":[{"code":"2523915","type":"CDM"},{"code":"637","type":"RC"},{"code":"00121086720","type":"NDC"}],"standard_charges":[{"gross_charge":187.86,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1 GM/200 ML BAG","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2523920","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.5 GM/300 ML BAG","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"2523921","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 2 GM/400 ML BAG","drug_information":{"unit":"400","type":"ML"},"code_information":[{"code":"2523922","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004402","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.25 GM/250 ML BAG","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2523923","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.75 GM/350 ML BAG","drug_information":{"unit":"350","type":"ML"},"code_information":[{"code":"2523924","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005802","type":"NDC"}],"standard_charges":[{"gross_charge":156.0,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 750 MG/150 ML BAG","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"2523925","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005603","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"}]},{"description":"Vancomycin","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2523930","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"Varivax 1350 units","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2523941","type":"CDM"},{"code":"636","type":"RC"},{"code":"90716","type":"HCPCS"},{"code":"00006482700","type":"NDC"}],"standard_charges":[{"gross_charge":2196.02,"setting":"both","billing_class":"facility"}]},{"description":"VASOSTRICT","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2523950","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":97.23,"setting":"both","billing_class":"facility"}]},{"description":"Entyvio 300mg SDV","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"2523961","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":42119.60,"setting":"both","billing_class":"facility"}]},{"description":"Norcuron","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2523980","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323078110","type":"NDC"}],"standard_charges":[{"gross_charge":34.14,"setting":"both","billing_class":"facility"}]},{"description":"Effexor XR","drug_information":{"unit":"75","type":"UN"},"code_information":[{"code":"2523983","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084070901","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"setting":"both","billing_class":"facility"}]},{"description":"Effexor XR","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"2523984","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084071301","type":"NDC"}],"standard_charges":[{"gross_charge":27.42,"setting":"both","billing_class":"facility"}]},{"description":"Effexor","drug_information":{"unit":"37.5","type":"UN"},"code_information":[{"code":"2523985","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084084401","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","billing_class":"facility"}]},{"description":"Effexor","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"2523986","type":"CDM"},{"code":"637","type":"RC"},{"code":"57237017401","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"setting":"both","billing_class":"facility"}]},{"description":"VERAPAMIL SR-FOR LTC ONLY (OUTPT STOCK)","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2523987","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591288001","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"setting":"both","billing_class":"facility"}]},{"description":"Calan 120mg","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"2523990","type":"CDM"},{"code":"637","type":"RC"},{"code":"00591034501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Calan SR","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"2523993","type":"CDM"},{"code":"637","type":"RC"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Calan SR","drug_information":{"unit":"240","type":"UN"},"code_information":[{"code":"2523996","type":"CDM"},{"code":"637","type":"RC"},{"code":"75834015901","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"setting":"both","billing_class":"facility"}]},{"description":"Calan","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2524000","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069027125","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"setting":"both","billing_class":"facility"}]},{"description":"Calan 80mg","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2524010","type":"CDM"},{"code":"637","type":"RC"},{"code":"00591034301","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Versed","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2524015","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":43.98,"setting":"both","billing_class":"facility"}]},{"description":"Viibryd","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2524041","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456111030","type":"NDC"}],"standard_charges":[{"gross_charge":69.48,"setting":"both","billing_class":"facility"}]},{"description":"Viibryd","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2524042","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456112030","type":"NDC"}],"standard_charges":[{"gross_charge":69.48,"setting":"both","billing_class":"facility"}]},{"description":"Viibryd","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2524043","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456114030","type":"NDC"}],"standard_charges":[{"gross_charge":69.48,"setting":"both","billing_class":"facility"}]},{"description":"Vinblastine Sulfate","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2524063","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":322.56,"setting":"both","billing_class":"facility"}]},{"description":"Vincristine Sulfate","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2524068","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"setting":"both","billing_class":"facility"}]},{"description":"Vincasar","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2524069","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":92.4,"setting":"both","billing_class":"facility"}]},{"description":"VINORELBINE TARTRATE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2524070","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"25021020401","type":"NDC"}],"standard_charges":[{"gross_charge":75.72,"setting":"both","billing_class":"facility"}]},{"description":"Allbee with C","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524150","type":"CDM"},{"code":"637","type":"RC"},{"code":"80681012600","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"A&D Ointment 4 oz","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524170","type":"CDM"},{"code":"270","type":"RC"},{"code":"71399012204","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin B1","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2524189","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268085115","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Thiamine","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2524191","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72485050725","type":"NDC"}],"standard_charges":[{"gross_charge":44.64,"setting":"both","billing_class":"facility"}]},{"description":"Theragran-M","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524196","type":"CDM"},{"code":"637","type":"RC"},{"code":"40985022368","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin C","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"2524198","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Vitamin B12","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2524199","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":41.94,"setting":"both","billing_class":"facility"}]},{"description":"Theragram","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524204","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904053961","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Trintellix","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2524213","type":"CDM"},{"code":"252","type":"RC"},{"code":"64764073030","type":"NDC"}],"standard_charges":[{"gross_charge":97.92,"setting":"both","billing_class":"facility"}]},{"description":"Vfend","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2524214","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"70594006701","type":"NDC"}],"standard_charges":[{"gross_charge":210.0,"setting":"both","billing_class":"facility"}]},{"description":"VORICONAZOLE","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2524215","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"65862089230","type":"NDC"}],"standard_charges":[{"gross_charge":29.27,"setting":"both","billing_class":"facility"}]},{"description":"Coumadin","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524246","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832121101","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"JANTOVEN","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"2524247","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coumadin","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"2524250","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coumadin","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2524251","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832121601","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coumadin","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"2524252","type":"CDM"},{"code":"637","type":"RC"},{"code":"00832121401","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Coumadin","drug_information":{"unit":"2.5","type":"UN"},"code_information":[{"code":"2524280","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084002701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Tucks Pads","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524330","type":"CDM"},{"code":"250","type":"RC"},{"code":"50289325001","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"setting":"both","billing_class":"facility"}]},{"description":"Zanosar","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524377","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9320","type":"HCPCS"},{"code":"00703463601","type":"NDC"}],"standard_charges":[{"gross_charge":2304.88,"setting":"both","billing_class":"facility"}]},{"description":"Zemuron","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2524378","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042605","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"}]},{"description":"Ziac 5/6.25mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524379","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300018813","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Retrovir","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2524391","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3485","type":"HCPCS"},{"code":"49702021326","type":"NDC"}],"standard_charges":[{"gross_charge":175.14,"setting":"both","billing_class":"facility"}]},{"description":"Desitin 28gm","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524460","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122067646","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"setting":"both","billing_class":"facility"}]},{"description":"ZINC SULFATE","drug_information":{"unit":"220","type":"UN"},"code_information":[{"code":"2524461","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333098310","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID 4 MG/100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2524532","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"70860021051","type":"NDC"}],"standard_charges":[{"gross_charge":285.0,"setting":"both","billing_class":"facility"}]},{"description":"Reclast","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2524533","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"68001043725","type":"NDC"}],"standard_charges":[{"gross_charge":245.7,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2524534","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":218.58,"setting":"both","billing_class":"facility"}]},{"description":"Geodon","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"2524535","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084010309","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"setting":"both","billing_class":"facility"}]},{"description":"Geodon","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2524536","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"72266016010","type":"NDC"}],"standard_charges":[{"gross_charge":196.74,"setting":"both","billing_class":"facility"}]},{"description":"Geodon","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"2524537","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084010409","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"setting":"both","billing_class":"facility"}]},{"description":"Geodon","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"2524539","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084010609","type":"NDC"}],"standard_charges":[{"gross_charge":61.62,"setting":"both","billing_class":"facility"}]},{"description":"LOKELMA","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"2524540","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310111039","type":"NDC"}],"standard_charges":[{"gross_charge":164.1,"setting":"both","billing_class":"facility"}]},{"description":"ZYNRELEF 200-6 MG/7 ML VIAL","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"2524541","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":918.66,"setting":"both","billing_class":"facility"}]},{"description":"ZYNRELEF 400-12 MG/14 ML VIAL","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"2524542","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030102","type":"NDC"}],"standard_charges":[{"gross_charge":1662.54,"setting":"both","billing_class":"facility"}]},{"description":"Ambien","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"2524600","type":"CDM"},{"code":"637","type":"RC"},{"code":"00904608261","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"setting":"both","billing_class":"facility"}]},{"description":"Zonegran","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"2524601","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687023001","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"setting":"both","billing_class":"facility"}]},{"description":"I131 THERAPEUTIC PER MCI","code_information":[{"code":"2550125","type":"CDM"},{"code":"344","type":"RC"},{"code":"A9517","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"I-123 SODIUM IOD CAPS-PER 100M","code_information":[{"code":"2550140","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"FLOTUFLSTT F-18, POSLUMA 1MCI","code_information":[{"code":"2550141","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9608","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.25,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":578.25,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"TC99M LABELED R BL0OD CELL<30","code_information":[{"code":"2550308","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M SESTAMIB PER DOSE 0-40M","code_information":[{"code":"2550310","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M MEMBROFENI PER DOSE 0-15","code_information":[{"code":"2550316","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M MACROAGGR ALB PER S 0-20","code_information":[{"code":"2550321","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M MEDRONATE 0-30 MCI","code_information":[{"code":"2550330","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M SULFUR COLLOID PER ST<20","code_information":[{"code":"2550333","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M PYROPHOSPHATE =<25MCI","code_information":[{"code":"2550336","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9538","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99 PENTETAT AEROS DOSE  >75M","code_information":[{"code":"2550338","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9567","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M PERTECHNETATE PER MCI","code_information":[{"code":"2550343","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"THALLIUM (THAL CHL 201)PR MCI","code_information":[{"code":"2550345","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9505","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TC99M MERTIATIDE PER STUD<15","code_information":[{"code":"2550346","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"GADOLINIUM PER ML-MRI","code_information":[{"code":"2550402","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-AC","code_information":[{"code":"2601050","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":659.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-2N","code_information":[{"code":"2601053","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":332.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-INF","code_information":[{"code":"2601100","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-3S","code_information":[{"code":"2601101","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-AC","code_information":[{"code":"2601102","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-2N","code_information":[{"code":"2601103","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-ICU","code_information":[{"code":"2601104","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-ICU","code_information":[{"code":"2601105","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":293.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-INF","code_information":[{"code":"2601106","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":293.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-3S","code_information":[{"code":"2601107","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-AC","code_information":[{"code":"2601108","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":293.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-2N","code_information":[{"code":"2601109","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":293.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-4S","code_information":[{"code":"2601110","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-INF","code_information":[{"code":"2601111","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-3S","code_information":[{"code":"2601112","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-2N","code_information":[{"code":"2601113","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-COV ICU","code_information":[{"code":"2601114","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-AC","code_information":[{"code":"2601115","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-INF","code_information":[{"code":"2601116","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-3S","code_information":[{"code":"2601117","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-4S","code_information":[{"code":"2601118","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-3S","code_information":[{"code":"2601119","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-ICU","code_information":[{"code":"2601120","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-INF","code_information":[{"code":"2601121","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-INF","code_information":[{"code":"2601122","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-3S","code_information":[{"code":"2601123","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-4S","code_information":[{"code":"2601124","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-2N","code_information":[{"code":"2601125","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-AC","code_information":[{"code":"2601126","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-ICU","code_information":[{"code":"2601127","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-ICU","code_information":[{"code":"2601128","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-2N","code_information":[{"code":"2601130","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-AC","code_information":[{"code":"2601131","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-4S","code_information":[{"code":"2601132","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-NUR","code_information":[{"code":"2601133","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-NUR","code_information":[{"code":"2601134","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-PCU","code_information":[{"code":"2601137","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-PCU","code_information":[{"code":"2601138","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-PCU","code_information":[{"code":"2601139","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION ADDL-PCU","code_information":[{"code":"2601140","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":293.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-PCU","code_information":[{"code":"2601142","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-ICU","code_information":[{"code":"2601143","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-PCU","code_information":[{"code":"2601144","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":225.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-4S","code_information":[{"code":"2601145","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-4S","code_information":[{"code":"2601148","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-OKI","code_information":[{"code":"2601149","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-OKI","code_information":[{"code":"2601150","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":286.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY HYDRATION INIT-OKI","code_information":[{"code":"2601151","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THER HYDRATION ADDL-OKI","code_information":[{"code":"2601152","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":513.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY CONCURRENT-OKI","code_information":[{"code":"2601153","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV INFUSION ADDL DRUG-OKI","code_information":[{"code":"2601154","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-4W","code_information":[{"code":"2601155","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":764.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG ADDL HR-4W","code_information":[{"code":"2601156","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":384.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"CERVICAL DILATION BALLOON","code_information":[{"code":"2701675","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":207.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ER EQUIP-BLOOD WARMER","code_information":[{"code":"2702988","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":285.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":208.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ER EQUIP GAYMER THERMIA UNIT","code_information":[{"code":"2703085","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":246.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"KIT ROBOTIC GENERAL PROC","code_information":[{"code":"2704600","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":98.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"KIT ROBOTIC OB/GYN PROC","code_information":[{"code":"2704601","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"KIT ROBOTIC TOTAL HIP PROC","code_information":[{"code":"2704602","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":214.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"KIT ROBOTIC TOTAL KNEE PROC","code_information":[{"code":"2704603","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"CERIBELL EEG HEADBND,PEDIATRIC","code_information":[{"code":"2709958","type":"CDM"},{"code":"622","type":"RC"}],"standard_charges":[{"gross_charge":1918.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"CERIBELL EEG HEADBAND, ADULT","code_information":[{"code":"2709959","type":"CDM"},{"code":"622","type":"RC"}],"standard_charges":[{"gross_charge":1918.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ARTHROSCOPY SHAVER","code_information":[{"code":"2715000","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"INSUFFLATOR","code_information":[{"code":"2715004","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"LASERS","code_information":[{"code":"2715005","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1914.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"RADIOFREQUENCY ABLATION UNIT","code_information":[{"code":"2715010","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ENDO SCOPES","code_information":[{"code":"2715014","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ENDO INSUFFLATOR","code_information":[{"code":"2715015","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ENDO VIDEO CART CHARGE","code_information":[{"code":"2715016","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1085.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"ENDO SCOPES ADDL","code_information":[{"code":"2715017","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":396.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TUBE TRACH CUFF/REA 6.0","code_information":[{"code":"2727413","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":89.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"MISC IMPLANT SPACEOAR C1889","code_information":[{"code":"2780011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9591.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"TISSUE MARKER IMPL-US/MRI/MAMM","code_information":[{"code":"2780282","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"IV THERAPY DIAG 1ST HR-OB/3N","code_information":[{"code":"2796365","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":659.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"INTERACTIVE COMPLEX ADD ON-PRO","code_information":[{"code":"2801281","type":"CDM"},{"code":"361","type":"RC"},{"code":"90785","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"PSY DX EVALUATION-PRO","code_information":[{"code":"2801282","type":"CDM"},{"code":"361","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"PSY DX EVAL W/MEDICAL SERV-PRO","code_information":[{"code":"2801283","type":"CDM"},{"code":"361","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":249.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-PRO","code_information":[{"code":"2801330","type":"CDM"},{"code":"361","type":"RC"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-PRO","code_information":[{"code":"2801331","type":"CDM"},{"code":"361","type":"RC"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-PRO","code_information":[{"code":"2801332","type":"CDM"},{"code":"361","type":"RC"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801340","type":"CDM"},{"code":"361","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801340","type":"CDM"},{"code":"361","type":"RC"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801341","type":"CDM"},{"code":"361","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801341","type":"CDM"},{"code":"361","type":"RC"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801342","type":"CDM"},{"code":"361","type":"RC"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-LTC","code_information":[{"code":"2801342","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801343","type":"CDM"},{"code":"361","type":"RC"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801343","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801344","type":"CDM"},{"code":"361","type":"RC"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801344","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801345","type":"CDM"},{"code":"361","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801345","type":"CDM"},{"code":"361","type":"RC"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801346","type":"CDM"},{"code":"361","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-LTC","code_information":[{"code":"2801346","type":"CDM"},{"code":"361","type":"RC"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-LTC","code_information":[{"code":"2801348","type":"CDM"},{"code":"361","type":"RC"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-LTC","code_information":[{"code":"2801348","type":"CDM"},{"code":"361","type":"RC"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-LTC","code_information":[{"code":"2801349","type":"CDM"},{"code":"361","type":"RC"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-LTC","code_information":[{"code":"2801349","type":"CDM"},{"code":"361","type":"RC"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801350","type":"CDM"},{"code":"361","type":"RC"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801350","type":"CDM"},{"code":"361","type":"RC"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801351","type":"CDM"},{"code":"361","type":"RC"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801351","type":"CDM"},{"code":"361","type":"RC"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801352","type":"CDM"},{"code":"361","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801352","type":"CDM"},{"code":"361","type":"RC"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"NURSING FAC CARE INIT-PRO","code_information":[{"code":"2801365","type":"CDM"},{"code":"361","type":"RC"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-PRO","code_information":[{"code":"2801365","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-PRO","code_information":[{"code":"2801366","type":"CDM"},{"code":"361","type":"RC"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-PRO","code_information":[{"code":"2801366","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE INIT-PRO","code_information":[{"code":"2801367","type":"CDM"},{"code":"361","type":"RC"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-PRO","code_information":[{"code":"2801368","type":"CDM"},{"code":"361","type":"RC"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-PRO","code_information":[{"code":"2801369","type":"CDM"},{"code":"361","type":"RC"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-PRO","code_information":[{"code":"2801370","type":"CDM"},{"code":"361","type":"RC"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC CARE SUBSEQ-PRO","code_information":[{"code":"2801371","type":"CDM"},{"code":"361","type":"RC"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-PRO","code_information":[{"code":"2801372","type":"CDM"},{"code":"361","type":"RC"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-PRO","code_information":[{"code":"2801372","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-PRO","code_information":[{"code":"2801373","type":"CDM"},{"code":"361","type":"RC"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NURSING FAC DISCHARGE DAY-PRO","code_information":[{"code":"2801373","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT EST PATIENT-PRO","code_information":[{"code":"2801379","type":"CDM"},{"code":"361","type":"RC"},{"code":"99348","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"PROLONGED SERV INPATIENT-PRO","code_information":[{"code":"2801380","type":"CDM"},{"code":"361","type":"RC"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":162.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"NB CARENOT IN HOSP-PRO","code_information":[{"code":"2801384","type":"CDM"},{"code":"361","type":"RC"},{"code":"99461","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"},{"gross_charge":116.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT NEW PATIENT-PRO","code_information":[{"code":"2801403","type":"CDM"},{"code":"361","type":"RC"},{"code":"99341","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT NEW PATIENT-PRO","code_information":[{"code":"2801404","type":"CDM"},{"code":"361","type":"RC"},{"code":"99342","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT NEW PATIENT-PRO","code_information":[{"code":"2801406","type":"CDM"},{"code":"361","type":"RC"},{"code":"99344","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT NEW PATIENT-PRO","code_information":[{"code":"2801407","type":"CDM"},{"code":"361","type":"RC"},{"code":"99345","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT EST PATIENT-PRO","code_information":[{"code":"2801408","type":"CDM"},{"code":"361","type":"RC"},{"code":"99347","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT EST PATIENT-PRO","code_information":[{"code":"2801409","type":"CDM"},{"code":"361","type":"RC"},{"code":"99349","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT EST PATIENT-PRO","code_information":[{"code":"2801410","type":"CDM"},{"code":"361","type":"RC"},{"code":"99350","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"HOME VISIT PROLONG-PRO","code_information":[{"code":"2801411","type":"CDM"},{"code":"361","type":"RC"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-PRO","code_information":[{"code":"2801412","type":"CDM"},{"code":"361","type":"RC"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC SUBSEQ-LTC","code_information":[{"code":"2801413","type":"CDM"},{"code":"361","type":"RC"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-PRO","code_information":[{"code":"2801414","type":"CDM"},{"code":"361","type":"RC"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-LTC","code_information":[{"code":"2801415","type":"CDM"},{"code":"361","type":"RC"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-PRO","code_information":[{"code":"2801416","type":"CDM"},{"code":"361","type":"RC"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":239.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-LTC","code_information":[{"code":"2801417","type":"CDM"},{"code":"361","type":"RC"},{"code":"64581","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"VIRTUAL NURS FAC CARE INIT-LTC","code_information":[{"code":"2801417","type":"CDM"},{"code":"361","type":"RC"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-PRO","code_information":[{"code":"2801418","type":"CDM"},{"code":"361","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL NURS FAC CARE INIT-PRO","code_information":[{"code":"2801418","type":"CDM"},{"code":"361","type":"RC"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC CARE INIT-LTC","code_information":[{"code":"2801419","type":"CDM"},{"code":"361","type":"RC"},{"code":"49324","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL NURS FAC CARE INIT-LTC","code_information":[{"code":"2801419","type":"CDM"},{"code":"361","type":"RC"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC DISCH DAY-PRO","code_information":[{"code":"2801420","type":"CDM"},{"code":"361","type":"RC"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC DISCH DAY-LTC","code_information":[{"code":"2801421","type":"CDM"},{"code":"361","type":"RC"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC DISCH DAY-PRO","code_information":[{"code":"2801422","type":"CDM"},{"code":"361","type":"RC"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURS FAC DISCH DAY-LTC","code_information":[{"code":"2801423","type":"CDM"},{"code":"361","type":"RC"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"REM IMPACTED EAR WAX-LTC","code_information":[{"code":"2801435","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EARWAX BIL-LTC","code_information":[{"code":"2801436","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM IMPACT WAX W/TOOL-LTC","code_information":[{"code":"2801437","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACT WAX W/TOOL BIL-LTC","code_information":[{"code":"2801438","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM IMPACTED EAR WAX-PRO","code_information":[{"code":"2801439","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EARWAX BIL-PRO","code_information":[{"code":"2801440","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM IMPACT WAX W/TOOL-PRO","code_information":[{"code":"2801441","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACT WAX W/TOOL BIL-PRO","code_information":[{"code":"2801442","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"OFFICE EMERGENCY CARE-URG","code_information":[{"code":"2801604","type":"CDM"},{"code":"519","type":"RC"},{"code":"99058","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"URGENT CARE CTR GLBL-URG ONLY","code_information":[{"code":"2804103","type":"CDM"},{"code":"519","type":"RC"},{"code":"S9083","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"AETNA URGENT CARE CTR-URG ONLY","code_information":[{"code":"2804104","type":"CDM"},{"code":"519","type":"RC"},{"code":"S9083","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/O IMAGE-PhHOS","code_information":[{"code":"2810010","type":"CDM"},{"code":"361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"facility"},{"gross_charge":97.0,"setting":"both","billing_class":"professional"}]},{"description":"I&D ABSCESS SIMPL/SINGLE-PhHOS","code_information":[{"code":"2810011","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"I&D ABSCESS MULT/COMP-PhHOS","code_information":[{"code":"2810012","type":"CDM"},{"code":"361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"facility"},{"gross_charge":264.25,"setting":"both","billing_class":"professional"}]},{"description":"I&D PILONIDAL CYST SIMPL-PhHOS","code_information":[{"code":"2810013","type":"CDM"},{"code":"361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"facility"},{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"I&D PILONIDAL CYST COMP-PhHOS","code_information":[{"code":"2810014","type":"CDM"},{"code":"361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"facility"},{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"INC&REM FB SUBQ TIS SMPL-PhHOS","code_information":[{"code":"2810015","type":"CDM"},{"code":"361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"facility"},{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"INC&REM FB SUBQ TIS COMP-PhHOS","code_information":[{"code":"2810016","type":"CDM"},{"code":"361","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"setting":"both","billing_class":"facility"},{"gross_charge":354.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN HEMATOMA/FLUID-PhHOS","code_information":[{"code":"2810017","type":"CDM"},{"code":"361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE DRAIN LES-PhHOS","code_information":[{"code":"2810018","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"facility"},{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEX DRAINAGE WND-PhHOS","code_information":[{"code":"2810019","type":"CDM"},{"code":"361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.5,"setting":"both","billing_class":"facility"},{"gross_charge":328.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE INFECTED SK-PhHOS","code_information":[{"code":"2810020","type":"CDM"},{"code":"361","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE GENITALIA/PERIN-PhHOS","code_information":[{"code":"2810021","type":"CDM"},{"code":"361","type":"RC"},{"code":"11004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.5,"setting":"both","billing_class":"facility"},{"gross_charge":1089.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE ABDOM WALL-PhHOS","code_information":[{"code":"2810022","type":"CDM"},{"code":"361","type":"RC"},{"code":"11005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.75,"setting":"both","billing_class":"facility"},{"gross_charge":1461.75,"setting":"both","billing_class":"professional"}]},{"description":"REM MESH FROM ABD WALL-PhHOS","code_information":[{"code":"2810023","type":"CDM"},{"code":"361","type":"RC"},{"code":"11008","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.25,"setting":"both","billing_class":"facility"},{"gross_charge":514.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SK FX-PhHOS","code_information":[{"code":"2810024","type":"CDM"},{"code":"361","type":"RC"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.5,"setting":"both","billing_class":"facility"},{"gross_charge":528.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SK/MSCL FX-PhHOS","code_information":[{"code":"2810025","type":"CDM"},{"code":"361","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.5,"setting":"both","billing_class":"facility"},{"gross_charge":786.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SK/MSCL/BONE FX-PhHOS","code_information":[{"code":"2810026","type":"CDM"},{"code":"361","type":"RC"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.75,"setting":"both","billing_class":"facility"},{"gross_charge":794.75,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SK/TISSUE-PhHOS","code_information":[{"code":"2810027","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.5,"setting":"both","billing_class":"facility"},{"gross_charge":116.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE/MSCL-PhHOS","code_information":[{"code":"2810028","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"facility"},{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE/MSCL/BONE-PhHOS","code_information":[{"code":"2810029","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.75,"setting":"both","billing_class":"facility"},{"gross_charge":438.75,"setting":"both","billing_class":"professional"}]},{"description":"DEB SUBQ TISSUE ADD-ON-PhHOS","code_information":[{"code":"2810030","type":"CDM"},{"code":"361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"DEB MUSC/FASCIA ADD-ON-PhHOS","code_information":[{"code":"2810031","type":"CDM"},{"code":"361","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"DEB BONE ADD-ON-PhHOS","code_information":[{"code":"2810032","type":"CDM"},{"code":"361","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"facility"},{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SK LES-PhHOS","code_information":[{"code":"2810033","type":"CDM"},{"code":"361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SK LESS 2 TO 4-PhHOS","code_information":[{"code":"2810034","type":"CDM"},{"code":"361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SK LESS OVER 4-PhHOS","code_information":[{"code":"2810035","type":"CDM"},{"code":"361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"facility"},{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SK TAGS-PhHOS","code_information":[{"code":"2810038","type":"CDM"},{"code":"361","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"REM SK TAGS ADD-ON-PhHOS","code_information":[{"code":"2810039","type":"CDM"},{"code":"361","type":"RC"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.75,"setting":"both","billing_class":"facility"},{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESN 0.5 CM/<-PhHOS","code_information":[{"code":"2810040","type":"CDM"},{"code":"361","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 0.6-1.0 CM-PhHOS","code_information":[{"code":"2810041","type":"CDM"},{"code":"361","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.75,"setting":"both","billing_class":"facility"},{"gross_charge":77.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 1.1-2.0 CM-PhHOS","code_information":[{"code":"2810042","type":"CDM"},{"code":"361","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"facility"},{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION >2.0CM-PhHOS","code_information":[{"code":"2810043","type":"CDM"},{"code":"361","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"facility"},{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESN 0.5CM/<-PhHOS","code_information":[{"code":"2810044","type":"CDM"},{"code":"361","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 0.6-1.0 CM-PhHOS","code_information":[{"code":"2810045","type":"CDM"},{"code":"361","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 1.1-2.0 CM-PhHOS","code_information":[{"code":"2810046","type":"CDM"},{"code":"361","type":"RC"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"facility"},{"gross_charge":97.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION >2.0CM-PhHOS","code_information":[{"code":"2810047","type":"CDM"},{"code":"361","type":"RC"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.75,"setting":"both","billing_class":"facility"},{"gross_charge":138.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESN 0.5 CM/<-PhHOS","code_information":[{"code":"2810048","type":"CDM"},{"code":"361","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"facility"},{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 0.6-1.0 CM-PhHOS","code_information":[{"code":"2810049","type":"CDM"},{"code":"361","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SK LES 1.1-2.0 CM-PhHOS","code_information":[{"code":"2810050","type":"CDM"},{"code":"361","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION >2.0CM-PhHOS","code_information":[{"code":"2810051","type":"CDM"},{"code":"361","type":"RC"},{"code":"11313","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"facility"},{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 0.5 <CM-PhHOS","code_information":[{"code":"2810052","type":"CDM"},{"code":"361","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"facility"},{"gross_charge":118.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 0.6-1CM-PhHOS","code_information":[{"code":"2810053","type":"CDM"},{"code":"361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"facility"},{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 1.1-2CM-PhHOS","code_information":[{"code":"2810054","type":"CDM"},{"code":"361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.5,"setting":"both","billing_class":"facility"},{"gross_charge":168.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 2.1-3CM-PhHOS","code_information":[{"code":"2810055","type":"CDM"},{"code":"361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.5,"setting":"both","billing_class":"facility"},{"gross_charge":279.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 3.1-4CM-PhHOS","code_information":[{"code":"2810056","type":"CDM"},{"code":"361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.25,"setting":"both","billing_class":"facility"},{"gross_charge":308.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX B9 > 4.0CM-PhHOS","code_information":[{"code":"2810057","type":"CDM"},{"code":"361","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.25,"setting":"both","billing_class":"facility"},{"gross_charge":465.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 0.5 <-PhHOS","code_information":[{"code":"2810058","type":"CDM"},{"code":"361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.5,"setting":"both","billing_class":"facility"},{"gross_charge":120.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 0.6-1-PhHOS","code_information":[{"code":"2810059","type":"CDM"},{"code":"361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"facility"},{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 1.1-2-PhHOS","code_information":[{"code":"2810060","type":"CDM"},{"code":"361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 2.1-3-PhHOS","code_information":[{"code":"2810061","type":"CDM"},{"code":"361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"setting":"both","billing_class":"facility"},{"gross_charge":300.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 3.1-4-PhHOS","code_information":[{"code":"2810062","type":"CDM"},{"code":"361","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"setting":"both","billing_class":"facility"},{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S B9 > 4CM-PhHOS","code_information":[{"code":"2810063","type":"CDM"},{"code":"361","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.25,"setting":"both","billing_class":"facility"},{"gross_charge":517.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 0.5 <CM-PhHOS","code_information":[{"code":"2810064","type":"CDM"},{"code":"361","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"setting":"both","billing_class":"facility"},{"gross_charge":155.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 0.6-1CM-PhHOS","code_information":[{"code":"2810065","type":"CDM"},{"code":"361","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"facility"},{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 1.1-2CM-PhHOS","code_information":[{"code":"2810066","type":"CDM"},{"code":"361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"facility"},{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 2.1-3CM-PhHOS","code_information":[{"code":"2810067","type":"CDM"},{"code":"361","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.75,"setting":"both","billing_class":"facility"},{"gross_charge":339.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 3.1-4CM-PhHOS","code_information":[{"code":"2810068","type":"CDM"},{"code":"361","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.5,"setting":"both","billing_class":"facility"},{"gross_charge":429.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM B9 > 4CM-PhHOS","code_information":[{"code":"2810069","type":"CDM"},{"code":"361","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"setting":"both","billing_class":"facility"},{"gross_charge":453.0,"setting":"both","billing_class":"professional"}]},{"description":"REM SWEAT GLAND LES-PhHOS","code_information":[{"code":"2810070","type":"CDM"},{"code":"361","type":"RC"},{"code":"11450","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.5,"setting":"both","billing_class":"facility"},{"gross_charge":478.5,"setting":"both","billing_class":"professional"}]},{"description":"REM SWEAT GLAND LES-PhHOS","code_information":[{"code":"2810071","type":"CDM"},{"code":"361","type":"RC"},{"code":"11462","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.75,"setting":"both","billing_class":"facility"},{"gross_charge":439.75,"setting":"both","billing_class":"professional"}]},{"description":"REM SWEAT GLAND LES-PhHOS","code_information":[{"code":"2810072","type":"CDM"},{"code":"361","type":"RC"},{"code":"11470","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.25,"setting":"both","billing_class":"facility"},{"gross_charge":515.25,"setting":"both","billing_class":"professional"}]},{"description":"REM SWEAT GLAND LES-PhHOS","code_information":[{"code":"2810073","type":"CDM"},{"code":"361","type":"RC"},{"code":"11471","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"setting":"both","billing_class":"facility"},{"gross_charge":663.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG 0.5<CM-PhHOS","code_information":[{"code":"2810074","type":"CDM"},{"code":"361","type":"RC"},{"code":"11600","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"facility"},{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG 0.6-1CM-PhHOS","code_information":[{"code":"2810075","type":"CDM"},{"code":"361","type":"RC"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.5,"setting":"both","billing_class":"facility"},{"gross_charge":219.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG 1.1-2CM-PhHOS","code_information":[{"code":"2810076","type":"CDM"},{"code":"361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.75,"setting":"both","billing_class":"facility"},{"gross_charge":241.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG 2.1-3CM-PhHOS","code_information":[{"code":"2810077","type":"CDM"},{"code":"361","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.25,"setting":"both","billing_class":"facility"},{"gross_charge":369.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG 3.1-4CM-PhHOS","code_information":[{"code":"2810078","type":"CDM"},{"code":"361","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EX MLG > 4CM-PhHOS","code_information":[{"code":"2810079","type":"CDM"},{"code":"361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"setting":"both","billing_class":"facility"},{"gross_charge":603.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG 0.6-1-PhHOS","code_information":[{"code":"2810080","type":"CDM"},{"code":"361","type":"RC"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.75,"setting":"both","billing_class":"facility"},{"gross_charge":283.75,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG 1.1-2-PhHOS","code_information":[{"code":"2810081","type":"CDM"},{"code":"361","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"setting":"both","billing_class":"facility"},{"gross_charge":325.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG 2.1-3-PhHOS","code_information":[{"code":"2810082","type":"CDM"},{"code":"361","type":"RC"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"setting":"both","billing_class":"facility"},{"gross_charge":403.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG 3.1-4-PhHOS","code_information":[{"code":"2810083","type":"CDM"},{"code":"361","type":"RC"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"setting":"both","billing_class":"facility"},{"gross_charge":455.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG > 4CM-PhHOS","code_information":[{"code":"2810084","type":"CDM"},{"code":"361","type":"RC"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"setting":"both","billing_class":"facility"},{"gross_charge":557.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG 0.5 <-PhHOS","code_information":[{"code":"2810085","type":"CDM"},{"code":"361","type":"RC"},{"code":"11640","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"facility"},{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG 0.6-1-PhHOS","code_information":[{"code":"2810086","type":"CDM"},{"code":"361","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.75,"setting":"both","billing_class":"facility"},{"gross_charge":230.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG 1.1-2-PhHOS","code_information":[{"code":"2810087","type":"CDM"},{"code":"361","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"setting":"both","billing_class":"facility"},{"gross_charge":349.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG 2.1-3-PhHOS","code_information":[{"code":"2810088","type":"CDM"},{"code":"361","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.75,"setting":"both","billing_class":"facility"},{"gross_charge":436.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG 3.1-4-PhHOS","code_information":[{"code":"2810089","type":"CDM"},{"code":"361","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.75,"setting":"both","billing_class":"facility"},{"gross_charge":539.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC-MM MLG > 4CM-PhHOS","code_information":[{"code":"2810090","type":"CDM"},{"code":"361","type":"RC"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.75,"setting":"both","billing_class":"facility"},{"gross_charge":746.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIM NAIL-PhHOS","code_information":[{"code":"2810091","type":"CDM"},{"code":"361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"},{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE NAIL 1-5-PhHOS","code_information":[{"code":"2810092","type":"CDM"},{"code":"361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"facility"},{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NAIL PLATE-PhHOS","code_information":[{"code":"2810093","type":"CDM"},{"code":"361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.5,"setting":"both","billing_class":"facility"},{"gross_charge":72.5,"setting":"both","billing_class":"professional"}]},{"description":"REM NAIL PLATE ADD-ON-PhHOS","code_information":[{"code":"2810094","type":"CDM"},{"code":"361","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN BLOOD FR UND NAIL-PhHOS","code_information":[{"code":"2810095","type":"CDM"},{"code":"361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NAIL BED-PhHOS","code_information":[{"code":"2810096","type":"CDM"},{"code":"361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"facility"},{"gross_charge":255.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF NAIL BED-PhHOS","code_information":[{"code":"2810098","type":"CDM"},{"code":"361","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"facility"},{"gross_charge":255.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF NAIL FOLD TOE-PhHOS","code_information":[{"code":"2810099","type":"CDM"},{"code":"361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.75,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","billing_class":"professional"}]},{"description":"RMVL PILONIDAL LES SMPL-PhHOS","code_information":[{"code":"2810100","type":"CDM"},{"code":"361","type":"RC"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"RMVL PILONIDAL LES EXTEN-PhHOS","code_information":[{"code":"2810101","type":"CDM"},{"code":"361","type":"RC"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.25,"setting":"both","billing_class":"facility"},{"gross_charge":819.25,"setting":"both","billing_class":"professional"}]},{"description":"REM PILONIDAL LES COMPL-PhHOS","code_information":[{"code":"2810102","type":"CDM"},{"code":"361","type":"RC"},{"code":"11772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.5,"setting":"both","billing_class":"facility"},{"gross_charge":1095.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ INTO SK LES-PhHOS","code_information":[{"code":"2810103","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"facility"},{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"ADDED SK LESS INJ-PhHOS","code_information":[{"code":"2810104","type":"CDM"},{"code":"361","type":"RC"},{"code":"11901","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"facility"},{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF CONTRACEPTIVE CAP-PhHOS","code_information":[{"code":"2810105","type":"CDM"},{"code":"361","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT DRUG IMPLANT DEV-PhHOS","code_information":[{"code":"2810106","type":"CDM"},{"code":"361","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"setting":"both","billing_class":"facility"},{"gross_charge":151.0,"setting":"both","billing_class":"professional"}]},{"description":"REM DRUG IMPLANT DEV-PhHOS","code_information":[{"code":"2810107","type":"CDM"},{"code":"361","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"facility"},{"gross_charge":184.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR SUPERFCL WND 2.5CM/<-PhHOS","code_information":[{"code":"2810108","type":"CDM"},{"code":"361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR SPRFCL WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810109","type":"CDM"},{"code":"361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"RPR SPRFCL WND7.6-12.5CM-PhHOS","code_information":[{"code":"2810110","type":"CDM"},{"code":"361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.75,"setting":"both","billing_class":"facility"},{"gross_charge":138.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR SPRFCL WND 12.6-20CM-PhHOS","code_information":[{"code":"2810111","type":"CDM"},{"code":"361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR SUPERFCL WND 2.5CM/<-PhHOS","code_information":[{"code":"2810112","type":"CDM"},{"code":"361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"RPR SPRFCL WND 2.6-5CM-PhHOS","code_information":[{"code":"2810113","type":"CDM"},{"code":"361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR SPRFCL WND 5.1-7.5CM-PhHOS","code_information":[{"code":"2810114","type":"CDM"},{"code":"361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"facility"},{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR SUPERFCL WND >30CM-PhHOS","code_information":[{"code":"2810115","type":"CDM"},{"code":"361","type":"RC"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"facility"},{"gross_charge":380.5,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE OF SPLIT WND-PhHOS","code_information":[{"code":"2810116","type":"CDM"},{"code":"361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.25,"setting":"both","billing_class":"facility"},{"gross_charge":358.25,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.5CM/<-PhHOS","code_information":[{"code":"2810117","type":"CDM"},{"code":"361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"setting":"both","billing_class":"facility"},{"gross_charge":227.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810118","type":"CDM"},{"code":"361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.5,"setting":"both","billing_class":"facility"},{"gross_charge":372.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 7.6-12.5CM-PhHOS","code_information":[{"code":"2810119","type":"CDM"},{"code":"361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.75,"setting":"both","billing_class":"facility"},{"gross_charge":392.75,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 12.6-20CM-PhHOS","code_information":[{"code":"2810120","type":"CDM"},{"code":"361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.25,"setting":"both","billing_class":"facility"},{"gross_charge":461.25,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WOUND 2.5CM/<-PhHOS","code_information":[{"code":"2810121","type":"CDM"},{"code":"361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"setting":"both","billing_class":"facility"},{"gross_charge":298.0,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810122","type":"CDM"},{"code":"361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"facility"},{"gross_charge":380.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 7.6-12.5CM-PhHOS","code_information":[{"code":"2810123","type":"CDM"},{"code":"361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 12.6-20CM-PhHOS","code_information":[{"code":"2810124","type":"CDM"},{"code":"361","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.25,"setting":"both","billing_class":"facility"},{"gross_charge":517.25,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.5CM/<-PhHOS","code_information":[{"code":"2810125","type":"CDM"},{"code":"361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.5,"setting":"both","billing_class":"facility"},{"gross_charge":326.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-5CM-PhHOS","code_information":[{"code":"2810126","type":"CDM"},{"code":"361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.75,"setting":"both","billing_class":"facility"},{"gross_charge":386.75,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 5.1-7.5CM-PhHOS","code_information":[{"code":"2810127","type":"CDM"},{"code":"361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"facility"},{"gross_charge":412.25,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 7.6-12.5CM-PhHOS","code_information":[{"code":"2810128","type":"CDM"},{"code":"361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.75,"setting":"both","billing_class":"facility"},{"gross_charge":434.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 1.1-2.5CM-PhHOS","code_information":[{"code":"2810129","type":"CDM"},{"code":"361","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.75,"setting":"both","billing_class":"facility"},{"gross_charge":389.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810130","type":"CDM"},{"code":"361","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.5,"setting":"both","billing_class":"facility"},{"gross_charge":483.5,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND ADD 5CM/<-PhHOS","code_information":[{"code":"2810131","type":"CDM"},{"code":"361","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"setting":"both","billing_class":"facility"},{"gross_charge":141.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 1.1-2.5CM-PhHOS","code_information":[{"code":"2810132","type":"CDM"},{"code":"361","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"setting":"both","billing_class":"facility"},{"gross_charge":451.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810133","type":"CDM"},{"code":"361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"setting":"both","billing_class":"facility"},{"gross_charge":508.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND ADD 5CM/<-PhHOS","code_information":[{"code":"2810134","type":"CDM"},{"code":"361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.25,"setting":"both","billing_class":"facility"},{"gross_charge":161.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 1.1-2.5CM-PhHOS","code_information":[{"code":"2810135","type":"CDM"},{"code":"361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.5,"setting":"both","billing_class":"facility"},{"gross_charge":474.5,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810136","type":"CDM"},{"code":"361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.75,"setting":"both","billing_class":"facility"},{"gross_charge":595.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND ADD 5CM/<-PhHOS","code_information":[{"code":"2810137","type":"CDM"},{"code":"361","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"facility"},{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX RPR WND 2.6-7.5CM-PhHOS","code_information":[{"code":"2810138","type":"CDM"},{"code":"361","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"setting":"both","billing_class":"facility"},{"gross_charge":609.0,"setting":"both","billing_class":"professional"}]},{"description":"SEC CLSR WND XTN/COMP-PhHOS","code_information":[{"code":"2810139","type":"CDM"},{"code":"361","type":"RC"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1532.25,"setting":"both","billing_class":"facility"},{"gross_charge":1532.25,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10 SQ CM/<-PhHOS","code_information":[{"code":"2810140","type":"CDM"},{"code":"361","type":"RC"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"setting":"both","billing_class":"facility"},{"gross_charge":965.0,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10.1-30SQCM-PhHOS","code_information":[{"code":"2810141","type":"CDM"},{"code":"361","type":"RC"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.5,"setting":"both","billing_class":"facility"},{"gross_charge":1249.5,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10 SQ CM/<-PhHOS","code_information":[{"code":"2810142","type":"CDM"},{"code":"361","type":"RC"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.5,"setting":"both","billing_class":"facility"},{"gross_charge":1089.5,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10.1-30SQCM-PhHOS","code_information":[{"code":"2810143","type":"CDM"},{"code":"361","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"setting":"both","billing_class":"facility"},{"gross_charge":1373.0,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10 SQ CM/<-PhHOS","code_information":[{"code":"2810144","type":"CDM"},{"code":"361","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.75,"setting":"both","billing_class":"facility"},{"gross_charge":1210.75,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10.1-30SQCM-PhHOS","code_information":[{"code":"2810145","type":"CDM"},{"code":"361","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.25,"setting":"both","billing_class":"facility"},{"gross_charge":1483.25,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10 SQ CM/<-PhHOS","code_information":[{"code":"2810146","type":"CDM"},{"code":"361","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.5,"setting":"both","billing_class":"facility"},{"gross_charge":1288.5,"setting":"both","billing_class":"professional"}]},{"description":"SK TIS TRNFR 10.1-30SQCM-PhHOS","code_information":[{"code":"2810147","type":"CDM"},{"code":"361","type":"RC"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.25,"setting":"both","billing_class":"facility"},{"gross_charge":1584.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ANY 30.1-60SQCM-PhHO","code_information":[{"code":"2810148","type":"CDM"},{"code":"361","type":"RC"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.0,"setting":"both","billing_class":"facility"},{"gross_charge":1683.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ADDL 30 SQ CM-PhHOS","code_information":[{"code":"2810149","type":"CDM"},{"code":"361","type":"RC"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.25,"setting":"both","billing_class":"facility"},{"gross_charge":409.25,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP TRK/ARM/LEG-PhHOS","code_information":[{"code":"2810150","type":"CDM"},{"code":"361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.5,"setting":"both","billing_class":"facility"},{"gross_charge":431.5,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP ADDL 100CM-PhHOS","code_information":[{"code":"2810151","type":"CDM"},{"code":"361","type":"RC"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"},{"gross_charge":86.75,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP F/N/HF/G-PhHOS","code_information":[{"code":"2810152","type":"CDM"},{"code":"361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.25,"setting":"both","billing_class":"facility"},{"gross_charge":513.25,"setting":"both","billing_class":"professional"}]},{"description":"HARVEST CULTURED SK GRFT-PhHOS","code_information":[{"code":"2810153","type":"CDM"},{"code":"361","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.75,"setting":"both","billing_class":"facility"},{"gross_charge":241.75,"setting":"both","billing_class":"professional"}]},{"description":"SK SPLT GRF TR/ARM/LEG-PhHOS","code_information":[{"code":"2810154","type":"CDM"},{"code":"361","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"setting":"both","billing_class":"facility"},{"gross_charge":1366.0,"setting":"both","billing_class":"professional"}]},{"description":"SK SPLT GRFT T/A/L ADDL-PhHOS","code_information":[{"code":"2810155","type":"CDM"},{"code":"361","type":"RC"},{"code":"15101","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.25,"setting":"both","billing_class":"facility"},{"gross_charge":209.25,"setting":"both","billing_class":"professional"}]},{"description":"EPID A-GRFT FC/NCK/HF/G-PhHOS","code_information":[{"code":"2810156","type":"CDM"},{"code":"361","type":"RC"},{"code":"15115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.25,"setting":"both","billing_class":"facility"},{"gross_charge":1436.25,"setting":"both","billing_class":"professional"}]},{"description":"SKN SPLT A-GRFT F/NK/H/G-PhHOS","code_information":[{"code":"2810157","type":"CDM"},{"code":"361","type":"RC"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"setting":"both","billing_class":"facility"},{"gross_charge":1326.0,"setting":"both","billing_class":"professional"}]},{"description":"DERM AUTOGRFT TRNK/A/L-PhHOS","code_information":[{"code":"2810158","type":"CDM"},{"code":"361","type":"RC"},{"code":"15130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.25,"setting":"both","billing_class":"facility"},{"gross_charge":1076.25,"setting":"both","billing_class":"professional"}]},{"description":"DERM AUTOGRFT T/A/L ADDL-PhHOS","code_information":[{"code":"2810159","type":"CDM"},{"code":"361","type":"RC"},{"code":"15131","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"SK FULL GRFT FC/GENIT/HF-PhHOS","code_information":[{"code":"2810160","type":"CDM"},{"code":"361","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.25,"setting":"both","billing_class":"facility"},{"gross_charge":1536.25,"setting":"both","billing_class":"professional"}]},{"description":"SK FULL GRFT EEN&LIPS-PhHOS","code_information":[{"code":"2810161","type":"CDM"},{"code":"361","type":"RC"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.5,"setting":"both","billing_class":"facility"},{"gross_charge":1645.5,"setting":"both","billing_class":"professional"}]},{"description":"SK SUB GRFT T/A/LG CHILD-PhHOS","code_information":[{"code":"2810162","type":"CDM"},{"code":"361","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.25,"setting":"both","billing_class":"facility"},{"gross_charge":365.25,"setting":"both","billing_class":"professional"}]},{"description":"SK GRFT T/A/L CHLD ADD-PhHOS","code_information":[{"code":"2810163","type":"CDM"},{"code":"361","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"SK SUB GRFT FC/NK/HF/G-PhHOS","code_information":[{"code":"2810164","type":"CDM"},{"code":"361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"facility"},{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"MSCL-SK GRFT TRUNK-PhHOS","code_information":[{"code":"2810165","type":"CDM"},{"code":"361","type":"RC"},{"code":"15734","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.75,"setting":"both","billing_class":"facility"},{"gross_charge":2842.75,"setting":"both","billing_class":"professional"}]},{"description":"MSCL-SK GRFT LEG-PhHOS","code_information":[{"code":"2810166","type":"CDM"},{"code":"361","type":"RC"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":2309.5,"setting":"both","billing_class":"facility"},{"gross_charge":2309.5,"setting":"both","billing_class":"professional"}]},{"description":"ACELLU DERM MATR IMPLT-PhHOS","code_information":[{"code":"2810167","type":"CDM"},{"code":"361","type":"RC"},{"code":"15777","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.5,"setting":"both","billing_class":"facility"},{"gross_charge":375.5,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UPPER LID-PhHOS","code_information":[{"code":"2810168","type":"CDM"},{"code":"361","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.25,"setting":"both","billing_class":"facility"},{"gross_charge":1077.25,"setting":"both","billing_class":"professional"}]},{"description":"EX EXESS SK SUBQ TISSUE-PhHOS","code_information":[{"code":"2810169","type":"CDM"},{"code":"361","type":"RC"},{"code":"15830","type":"HCPCS"}],"standard_charges":[{"gross_charge":2222.75,"setting":"both","billing_class":"facility"},{"gross_charge":2222.75,"setting":"both","billing_class":"professional"}]},{"description":"EX SK ABD ADD-ON-PhHOS","code_information":[{"code":"2810170","type":"CDM"},{"code":"361","type":"RC"},{"code":"15847","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.75,"setting":"both","billing_class":"facility"},{"gross_charge":692.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SUTURES-PhHOS","code_information":[{"code":"2810171","type":"CDM"},{"code":"361","type":"RC"},{"code":"15851","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"DRESSING CHANGE NOT BURN-PhHOS","code_information":[{"code":"2810172","type":"CDM"},{"code":"361","type":"RC"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL TX OF BURN-PhHOS","code_information":[{"code":"2810173","type":"CDM"},{"code":"361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","billing_class":"professional"}]},{"description":"DR/DEBRID P-THICK BURN S-PhHOS","code_information":[{"code":"2810174","type":"CDM"},{"code":"361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.25,"setting":"both","billing_class":"facility"},{"gross_charge":103.25,"setting":"both","billing_class":"professional"}]},{"description":"DR/DEBRID P-THICK BURN M-PhHOS","code_information":[{"code":"2810175","type":"CDM"},{"code":"361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.25,"setting":"both","billing_class":"facility"},{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"DR/DEBRID P-THICK BURN L-PhHOS","code_information":[{"code":"2810176","type":"CDM"},{"code":"361","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"setting":"both","billing_class":"facility"},{"gross_charge":252.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST BENIGN/PREMLG LES-PhHOS","code_information":[{"code":"2810177","type":"CDM"},{"code":"361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST LESS 2-14-PhHOS","code_information":[{"code":"2810178","type":"CDM"},{"code":"361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.25,"setting":"both","billing_class":"facility"},{"gross_charge":6.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST LESS 15 OR MORE-PhHOS","code_information":[{"code":"2810179","type":"CDM"},{"code":"361","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"facility"},{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LES 1-14-PhHOS","code_information":[{"code":"2810180","type":"CDM"},{"code":"361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"facility"},{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LES 15 OR MORE-PhHOS","code_information":[{"code":"2810181","type":"CDM"},{"code":"361","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"facility"},{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL CAUTERY TISSUE-PhHOS","code_information":[{"code":"2810182","type":"CDM"},{"code":"361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.5,"setting":"both","billing_class":"facility"},{"gross_charge":69.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L 0.5CM/<-PhHOS","code_information":[{"code":"2810183","type":"CDM"},{"code":"361","type":"RC"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L 0.6-1CM-PhHOS","code_information":[{"code":"2810184","type":"CDM"},{"code":"361","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L 1.1-2CM-PhHOS","code_information":[{"code":"2810185","type":"CDM"},{"code":"361","type":"RC"},{"code":"17262","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"setting":"both","billing_class":"facility"},{"gross_charge":171.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L 2.1-3CM-PhHOS","code_information":[{"code":"2810186","type":"CDM"},{"code":"361","type":"RC"},{"code":"17263","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"facility"},{"gross_charge":245.0,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L 3.1-4CM-PhHOS","code_information":[{"code":"2810187","type":"CDM"},{"code":"361","type":"RC"},{"code":"17264","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"facility"},{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES T/A/L >4.0CM-PhHOS","code_information":[{"code":"2810188","type":"CDM"},{"code":"361","type":"RC"},{"code":"17266","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"facility"},{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES SNHFG 0.6-1CM-PhHOS","code_information":[{"code":"2810189","type":"CDM"},{"code":"361","type":"RC"},{"code":"17271","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"setting":"both","billing_class":"facility"},{"gross_charge":178.0,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES SNHFG 1.1-2CM-PhHOS","code_information":[{"code":"2810190","type":"CDM"},{"code":"361","type":"RC"},{"code":"17272","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"setting":"both","billing_class":"facility"},{"gross_charge":243.0,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES SNHFG 2.1-3CM-PhHOS","code_information":[{"code":"2810191","type":"CDM"},{"code":"361","type":"RC"},{"code":"17273","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.5,"setting":"both","billing_class":"facility"},{"gross_charge":274.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES SNHFG 3.1-4CM-PhHOS","code_information":[{"code":"2810192","type":"CDM"},{"code":"361","type":"RC"},{"code":"17274","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"facility"},{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM 0.5CM/<-PhHOS","code_information":[{"code":"2810193","type":"CDM"},{"code":"361","type":"RC"},{"code":"17280","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM 0.6-1CM-PhHOS","code_information":[{"code":"2810194","type":"CDM"},{"code":"361","type":"RC"},{"code":"17281","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"facility"},{"gross_charge":184.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM 1.1-2CM-PhHOS","code_information":[{"code":"2810195","type":"CDM"},{"code":"361","type":"RC"},{"code":"17282","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","billing_class":"facility"},{"gross_charge":272.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM 2.1-3CM-PhHOS","code_information":[{"code":"2810196","type":"CDM"},{"code":"361","type":"RC"},{"code":"17283","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"setting":"both","billing_class":"facility"},{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM 3.1-4CM-PhHOS","code_information":[{"code":"2810197","type":"CDM"},{"code":"361","type":"RC"},{"code":"17284","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"setting":"both","billing_class":"facility"},{"gross_charge":396.0,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ LES FEENLM >4.0CM-PhHOS","code_information":[{"code":"2810198","type":"CDM"},{"code":"361","type":"RC"},{"code":"17286","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.75,"setting":"both","billing_class":"facility"},{"gross_charge":539.75,"setting":"both","billing_class":"professional"}]},{"description":"CRYOTHERAPY OF SK-PhHOS","code_information":[{"code":"2810199","type":"CDM"},{"code":"361","type":"RC"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"facility"},{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION BRST LES-PhHOS","code_information":[{"code":"2810200","type":"CDM"},{"code":"361","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"setting":"both","billing_class":"facility"},{"gross_charge":558.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF BRST OPEN-PhHOS","code_information":[{"code":"2810201","type":"CDM"},{"code":"361","type":"RC"},{"code":"19101","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.25,"setting":"both","billing_class":"facility"},{"gross_charge":417.25,"setting":"both","billing_class":"professional"}]},{"description":"NIPPLE EXPLORATION-PhHOS","code_information":[{"code":"2810202","type":"CDM"},{"code":"361","type":"RC"},{"code":"19110","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"setting":"both","billing_class":"facility"},{"gross_charge":652.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF BRST LES-PhHOS","code_information":[{"code":"2810203","type":"CDM"},{"code":"361","type":"RC"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.5,"setting":"both","billing_class":"facility"},{"gross_charge":779.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISION BRST LES-PhHOS","code_information":[{"code":"2810204","type":"CDM"},{"code":"361","type":"RC"},{"code":"19125","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.0,"setting":"both","billing_class":"facility"},{"gross_charge":866.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISION ADDL BRST LES-PhHOS","code_information":[{"code":"2810205","type":"CDM"},{"code":"361","type":"RC"},{"code":"19126","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","billing_class":"facility"},{"gross_charge":301.0,"setting":"both","billing_class":"professional"}]},{"description":"MASTECT FOR GYNECOMASTIA-PhHOS","code_information":[{"code":"2810206","type":"CDM"},{"code":"361","type":"RC"},{"code":"19300","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.5,"setting":"both","billing_class":"facility"},{"gross_charge":780.5,"setting":"both","billing_class":"professional"}]},{"description":"MASTECTOMY PARTIAL-PhHOS","code_information":[{"code":"2810207","type":"CDM"},{"code":"361","type":"RC"},{"code":"19301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1226.25,"setting":"both","billing_class":"facility"},{"gross_charge":1226.25,"setting":"both","billing_class":"professional"}]},{"description":"MASTECT W/LUMPHADENECT-PhHOS","code_information":[{"code":"2810208","type":"CDM"},{"code":"361","type":"RC"},{"code":"19302","type":"HCPCS"}],"standard_charges":[{"gross_charge":1689.25,"setting":"both","billing_class":"facility"},{"gross_charge":1689.25,"setting":"both","billing_class":"professional"}]},{"description":"MASTECTOMY SIMPLE COMPL-PhHOS","code_information":[{"code":"2810209","type":"CDM"},{"code":"361","type":"RC"},{"code":"19303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1897.25,"setting":"both","billing_class":"facility"},{"gross_charge":1897.25,"setting":"both","billing_class":"professional"}]},{"description":"MASTECT MODIFIED RADICAL-PhHOS","code_information":[{"code":"2810211","type":"CDM"},{"code":"361","type":"RC"},{"code":"19307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.25,"setting":"both","billing_class":"facility"},{"gross_charge":2251.25,"setting":"both","billing_class":"professional"}]},{"description":"SUSPENSION OF BRST-PhHOS","code_information":[{"code":"2810212","type":"CDM"},{"code":"361","type":"RC"},{"code":"19316","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.75,"setting":"both","billing_class":"facility"},{"gross_charge":1461.75,"setting":"both","billing_class":"professional"}]},{"description":"REDUCTION LARGE BRST-PhHOS","code_information":[{"code":"2810213","type":"CDM"},{"code":"361","type":"RC"},{"code":"19318","type":"HCPCS"}],"standard_charges":[{"gross_charge":2108.5,"setting":"both","billing_class":"facility"},{"gross_charge":2108.5,"setting":"both","billing_class":"professional"}]},{"description":"ENLARGE BRST W IMPLANT-PhHOS","code_information":[{"code":"2810214","type":"CDM"},{"code":"361","type":"RC"},{"code":"19325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.25,"setting":"both","billing_class":"facility"},{"gross_charge":1235.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF BRST IMPLANT-PhHOS","code_information":[{"code":"2810215","type":"CDM"},{"code":"361","type":"RC"},{"code":"19328","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.25,"setting":"both","billing_class":"facility"},{"gross_charge":925.25,"setting":"both","billing_class":"professional"}]},{"description":"DELAYED BRST PROSTHESIS-PhHOS","code_information":[{"code":"2810216","type":"CDM"},{"code":"361","type":"RC"},{"code":"19342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.75,"setting":"both","billing_class":"facility"},{"gross_charge":1765.75,"setting":"both","billing_class":"professional"}]},{"description":"BRST RECONSTRION-PhHOS","code_information":[{"code":"2810217","type":"CDM"},{"code":"361","type":"RC"},{"code":"19350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.5,"setting":"both","billing_class":"facility"},{"gross_charge":1289.5,"setting":"both","billing_class":"professional"}]},{"description":"BRST RECONSTRION-PhHOS","code_information":[{"code":"2810218","type":"CDM"},{"code":"361","type":"RC"},{"code":"19357","type":"HCPCS"}],"standard_charges":[{"gross_charge":2896.0,"setting":"both","billing_class":"facility"},{"gross_charge":2896.0,"setting":"both","billing_class":"professional"}]},{"description":"SURG OF BRST CAPSULE-PhHOS","code_information":[{"code":"2810219","type":"CDM"},{"code":"361","type":"RC"},{"code":"19370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.75,"setting":"both","billing_class":"facility"},{"gross_charge":1311.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF BRST CAPSULE-PhHOS","code_information":[{"code":"2810220","type":"CDM"},{"code":"361","type":"RC"},{"code":"19371","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.5,"setting":"both","billing_class":"facility"},{"gross_charge":1501.5,"setting":"both","billing_class":"professional"}]},{"description":"REV BRST RECONSTR-PhHOS","code_information":[{"code":"2810221","type":"CDM"},{"code":"361","type":"RC"},{"code":"19380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.5,"setting":"both","billing_class":"facility"},{"gross_charge":1451.5,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE WND ABDOMEN-PhHOS","code_information":[{"code":"2810223","type":"CDM"},{"code":"361","type":"RC"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.25,"setting":"both","billing_class":"facility"},{"gross_charge":469.25,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE WND EXREMITY-PhHOS","code_information":[{"code":"2810224","type":"CDM"},{"code":"361","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"DEEP MSCL BX-PhHOS","code_information":[{"code":"2810225","type":"CDM"},{"code":"361","type":"RC"},{"code":"20205","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.75,"setting":"both","billing_class":"facility"},{"gross_charge":291.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX EXISIONAL-PhHOS","code_information":[{"code":"2810226","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.25,"setting":"both","billing_class":"facility"},{"gross_charge":420.25,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX EXISIONAL-PhHOS","code_information":[{"code":"2810227","type":"CDM"},{"code":"361","type":"RC"},{"code":"20245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.25,"setting":"both","billing_class":"facility"},{"gross_charge":1182.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FB-PhHOS","code_information":[{"code":"2810228","type":"CDM"},{"code":"361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"facility"},{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FB-PhHOS","code_information":[{"code":"2810229","type":"CDM"},{"code":"361","type":"RC"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.25,"setting":"both","billing_class":"facility"},{"gross_charge":567.25,"setting":"both","billing_class":"professional"}]},{"description":"THER INJ CARP TUNNEL-PhHOS","code_information":[{"code":"2810230","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TEND SHEATH/LIGAM-PhHOS","code_information":[{"code":"2810231","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TEND ORIGIN/INSERT-PhHOS","code_information":[{"code":"2810232","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIG POINT 1/2 MUSCL-PhHOS","code_information":[{"code":"2810233","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"facility"},{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"INJECT TRIG POINTS =/> 3-PhHOS","code_information":[{"code":"2810234","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA-PhHOS","code_information":[{"code":"2810235","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA-PhHOS","code_information":[{"code":"2810236","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA-PhHOS","code_information":[{"code":"2810237","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"ASP/INJ GANGLION CYST-PhHOS","code_information":[{"code":"2810238","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.75,"setting":"both","billing_class":"facility"},{"gross_charge":77.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SUPPORT IMPLANT-PhHOS","code_information":[{"code":"2810239","type":"CDM"},{"code":"361","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.5,"setting":"both","billing_class":"facility"},{"gross_charge":219.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SUPPORT IMPLANT-PhHOS","code_information":[{"code":"2810240","type":"CDM"},{"code":"361","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"setting":"both","billing_class":"facility"},{"gross_charge":809.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY BONE FIXATION DEV-PhHOS","code_information":[{"code":"2810241","type":"CDM"},{"code":"361","type":"RC"},{"code":"20690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"setting":"both","billing_class":"facility"},{"gross_charge":1114.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY BONE FIXATION DEV-PhHOS","code_information":[{"code":"2810242","type":"CDM"},{"code":"361","type":"RC"},{"code":"20692","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.5,"setting":"both","billing_class":"facility"},{"gross_charge":2112.5,"setting":"both","billing_class":"professional"}]},{"description":"REM BONE FIXATION DEV-PhHOS","code_information":[{"code":"2810243","type":"CDM"},{"code":"361","type":"RC"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.75,"setting":"both","billing_class":"facility"},{"gross_charge":641.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF BONE FOR GRFT-PhHOS","code_information":[{"code":"2810244","type":"CDM"},{"code":"361","type":"RC"},{"code":"20902","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.5,"setting":"both","billing_class":"facility"},{"gross_charge":528.5,"setting":"both","billing_class":"professional"}]},{"description":"REM CARTILAGE FOR GRFT-PhHOS","code_information":[{"code":"2810245","type":"CDM"},{"code":"361","type":"RC"},{"code":"20912","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.25,"setting":"both","billing_class":"facility"},{"gross_charge":920.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TEND FOR GRFT-PhHOS","code_information":[{"code":"2810246","type":"CDM"},{"code":"361","type":"RC"},{"code":"20924","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.75,"setting":"both","billing_class":"facility"},{"gross_charge":952.75,"setting":"both","billing_class":"professional"}]},{"description":"ELECTRICAL BONE STIMULAT-PhHOS","code_information":[{"code":"2810248","type":"CDM"},{"code":"361","type":"RC"},{"code":"20974","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ <2CM-PhHOS","code_information":[{"code":"2810249","type":"CDM"},{"code":"361","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.75,"setting":"both","billing_class":"facility"},{"gross_charge":492.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ >2CM-PhHOS","code_information":[{"code":"2810250","type":"CDM"},{"code":"361","type":"RC"},{"code":"21012","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.5,"setting":"both","billing_class":"facility"},{"gross_charge":632.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FC TUM DEEP < 2CM-PhHOS","code_information":[{"code":"2810251","type":"CDM"},{"code":"361","type":"RC"},{"code":"21013","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.5,"setting":"both","billing_class":"facility"},{"gross_charge":738.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FC TUM DEEP = 2CM-PhHOS","code_information":[{"code":"2810252","type":"CDM"},{"code":"361","type":"RC"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.5,"setting":"both","billing_class":"facility"},{"gross_charge":985.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF NOSE FX-PhHOS","code_information":[{"code":"2810254","type":"CDM"},{"code":"361","type":"RC"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"setting":"both","billing_class":"facility"},{"gross_charge":295.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF NOSE FX-PhHOS","code_information":[{"code":"2810255","type":"CDM"},{"code":"361","type":"RC"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.25,"setting":"both","billing_class":"facility"},{"gross_charge":258.25,"setting":"both","billing_class":"professional"}]},{"description":"TX EYE SOCKET FX-PhHOS","code_information":[{"code":"2810256","type":"CDM"},{"code":"361","type":"RC"},{"code":"21390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.25,"setting":"both","billing_class":"facility"},{"gross_charge":1537.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN NECK/CHEST LES-PhHOS","code_information":[{"code":"2810257","type":"CDM"},{"code":"361","type":"RC"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.25,"setting":"both","billing_class":"facility"},{"gross_charge":619.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF NECK/CHEST-PhHOS","code_information":[{"code":"2810258","type":"CDM"},{"code":"361","type":"RC"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"setting":"both","billing_class":"facility"},{"gross_charge":300.0,"setting":"both","billing_class":"professional"}]},{"description":"EX LES NCK/CHEST SQ >3CM-PhHOS","code_information":[{"code":"2810259","type":"CDM"},{"code":"361","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.75,"setting":"both","billing_class":"facility"},{"gross_charge":844.75,"setting":"both","billing_class":"professional"}]},{"description":"EX NECK TUM DEEP = 5CM-PhHOS","code_information":[{"code":"2810260","type":"CDM"},{"code":"361","type":"RC"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"setting":"both","billing_class":"facility"},{"gross_charge":1377.0,"setting":"both","billing_class":"professional"}]},{"description":"REM LES NCK/CHEST SQ<3CM-PhHOS","code_information":[{"code":"2810261","type":"CDM"},{"code":"361","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.5,"setting":"both","billing_class":"facility"},{"gross_charge":586.5,"setting":"both","billing_class":"professional"}]},{"description":"EX NECK TUM DEEP < 5CM-PhHOS","code_information":[{"code":"2810262","type":"CDM"},{"code":"361","type":"RC"},{"code":"21556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"setting":"both","billing_class":"facility"},{"gross_charge":1014.0,"setting":"both","billing_class":"professional"}]},{"description":"REM LESBACK OR FLANK<3CM-PhHOS","code_information":[{"code":"2810263","type":"CDM"},{"code":"361","type":"RC"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.75,"setting":"both","billing_class":"facility"},{"gross_charge":695.75,"setting":"both","billing_class":"professional"}]},{"description":"REM LESBACK OR FLANK>3CM-PhHOS","code_information":[{"code":"2810264","type":"CDM"},{"code":"361","type":"RC"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.5,"setting":"both","billing_class":"facility"},{"gross_charge":890.5,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUM DEEP < 5CM-PhHOS","code_information":[{"code":"2810265","type":"CDM"},{"code":"361","type":"RC"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.25,"setting":"both","billing_class":"facility"},{"gross_charge":1225.25,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUM DEEP = 5CM-PhHOS","code_information":[{"code":"2810266","type":"CDM"},{"code":"361","type":"RC"},{"code":"21933","type":"HCPCS"}],"standard_charges":[{"gross_charge":1393.5,"setting":"both","billing_class":"facility"},{"gross_charge":1393.5,"setting":"both","billing_class":"professional"}]},{"description":"RESECT BACK TUM = 5CM-PhHOS","code_information":[{"code":"2810267","type":"CDM"},{"code":"361","type":"RC"},{"code":"21936","type":"HCPCS"}],"standard_charges":[{"gross_charge":2608.25,"setting":"both","billing_class":"facility"},{"gross_charge":2608.25,"setting":"both","billing_class":"professional"}]},{"description":"TX SPINE FX-PhHOS","code_information":[{"code":"2810269","type":"CDM"},{"code":"361","type":"RC"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.5,"setting":"both","billing_class":"facility"},{"gross_charge":533.5,"setting":"both","billing_class":"professional"}]},{"description":"TX SPINE FX-PhHOS","code_information":[{"code":"2810270","type":"CDM"},{"code":"361","type":"RC"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.75,"setting":"both","billing_class":"facility"},{"gross_charge":1463.75,"setting":"both","billing_class":"professional"}]},{"description":"REM ABD WALL LES-PhHOS","code_information":[{"code":"2810271","type":"CDM"},{"code":"361","type":"RC"},{"code":"22900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"setting":"both","billing_class":"facility"},{"gross_charge":1064.0,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUM DEEP = 5CM-PhHOS","code_information":[{"code":"2810272","type":"CDM"},{"code":"361","type":"RC"},{"code":"22901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.75,"setting":"both","billing_class":"facility"},{"gross_charge":1252.75,"setting":"both","billing_class":"professional"}]},{"description":"EX LES ABD WALL SQ <3CM-PhHOS","code_information":[{"code":"2810273","type":"CDM"},{"code":"361","type":"RC"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.25,"setting":"both","billing_class":"facility"},{"gross_charge":617.25,"setting":"both","billing_class":"professional"}]},{"description":"EX LES ABD WALL SQ > 3CM-PhHOS","code_information":[{"code":"2810274","type":"CDM"},{"code":"361","type":"RC"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.5,"setting":"both","billing_class":"facility"},{"gross_charge":838.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN SHOULDER LES-PhHOS","code_information":[{"code":"2810275","type":"CDM"},{"code":"361","type":"RC"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.25,"setting":"both","billing_class":"facility"},{"gross_charge":471.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SHOULDER LES >3CM-PhHOS","code_information":[{"code":"2810276","type":"CDM"},{"code":"361","type":"RC"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.75,"setting":"both","billing_class":"facility"},{"gross_charge":793.75,"setting":"both","billing_class":"professional"}]},{"description":"EX SHLDR TUM DEEP >5CM-PhHOS","code_information":[{"code":"2810277","type":"CDM"},{"code":"361","type":"RC"},{"code":"23073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.75,"setting":"both","billing_class":"facility"},{"gross_charge":1305.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SHOULDER LES <3CM-PhHOS","code_information":[{"code":"2810278","type":"CDM"},{"code":"361","type":"RC"},{"code":"23075","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.25,"setting":"both","billing_class":"facility"},{"gross_charge":623.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SHOULDER LES-PhHOS","code_information":[{"code":"2810279","type":"CDM"},{"code":"361","type":"RC"},{"code":"23076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.25,"setting":"both","billing_class":"facility"},{"gross_charge":1021.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM COLLAR BONE-PhHOS","code_information":[{"code":"2810280","type":"CDM"},{"code":"361","type":"RC"},{"code":"23120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.0,"setting":"both","billing_class":"facility"},{"gross_charge":1212.0,"setting":"both","billing_class":"professional"}]},{"description":"REM SHOULDER BONE PART-PhHOS","code_information":[{"code":"2810281","type":"CDM"},{"code":"361","type":"RC"},{"code":"23130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.75,"setting":"both","billing_class":"facility"},{"gross_charge":1153.75,"setting":"both","billing_class":"professional"}]},{"description":"REM SHOULDER FB DEEP-PhHOS","code_information":[{"code":"2810282","type":"CDM"},{"code":"361","type":"RC"},{"code":"23333","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.25,"setting":"both","billing_class":"facility"},{"gross_charge":828.25,"setting":"both","billing_class":"professional"}]},{"description":"REP ROTATOR CUFF ACUTE-PhHOS","code_information":[{"code":"2810283","type":"CDM"},{"code":"361","type":"RC"},{"code":"23410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.5,"setting":"both","billing_class":"facility"},{"gross_charge":1554.5,"setting":"both","billing_class":"professional"}]},{"description":"REP ROTATOR CUFF CHRONIC-PhHOS","code_information":[{"code":"2810284","type":"CDM"},{"code":"361","type":"RC"},{"code":"23412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.5,"setting":"both","billing_class":"facility"},{"gross_charge":1758.5,"setting":"both","billing_class":"professional"}]},{"description":"REP OF SHOULDER-PhHOS","code_information":[{"code":"2810285","type":"CDM"},{"code":"361","type":"RC"},{"code":"23420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.25,"setting":"both","billing_class":"facility"},{"gross_charge":1998.25,"setting":"both","billing_class":"professional"}]},{"description":"REP BICEPS TEND-PhHOS","code_information":[{"code":"2810286","type":"CDM"},{"code":"361","type":"RC"},{"code":"23430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"setting":"both","billing_class":"facility"},{"gross_charge":1418.0,"setting":"both","billing_class":"professional"}]},{"description":"REM/TRANSPLANT TEND-PhHOS","code_information":[{"code":"2810287","type":"CDM"},{"code":"361","type":"RC"},{"code":"23440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1428.0,"setting":"both","billing_class":"facility"},{"gross_charge":1428.0,"setting":"both","billing_class":"professional"}]},{"description":"REP SHOULDER CAPSULE-PhHOS","code_information":[{"code":"2810288","type":"CDM"},{"code":"361","type":"RC"},{"code":"23455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.25,"setting":"both","billing_class":"facility"},{"gross_charge":1840.25,"setting":"both","billing_class":"professional"}]},{"description":"REP SHOULDER CAPSULE-PhHOS","code_information":[{"code":"2810289","type":"CDM"},{"code":"361","type":"RC"},{"code":"23465","type":"HCPCS"}],"standard_charges":[{"gross_charge":2111.5,"setting":"both","billing_class":"facility"},{"gross_charge":2111.5,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTR SHOULDER JNT-PhHOS","code_information":[{"code":"2810290","type":"CDM"},{"code":"361","type":"RC"},{"code":"23470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2274.75,"setting":"both","billing_class":"facility"},{"gross_charge":2274.75,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTR SHOULDER JNT-PhHOS","code_information":[{"code":"2810291","type":"CDM"},{"code":"361","type":"RC"},{"code":"23472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2758.25,"setting":"both","billing_class":"facility"},{"gross_charge":2758.25,"setting":"both","billing_class":"professional"}]},{"description":"REV RECONST SHOULDER JNT-PhHOS","code_information":[{"code":"2810292","type":"CDM"},{"code":"361","type":"RC"},{"code":"23473","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.25,"setting":"both","billing_class":"facility"},{"gross_charge":3072.25,"setting":"both","billing_class":"professional"}]},{"description":"REV RECONST SHOULDER JNT-PhHOS","code_information":[{"code":"2810293","type":"CDM"},{"code":"361","type":"RC"},{"code":"23474","type":"HCPCS"}],"standard_charges":[{"gross_charge":3319.25,"setting":"both","billing_class":"facility"},{"gross_charge":3319.25,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF COLLAR BONE-PhHOS","code_information":[{"code":"2810294","type":"CDM"},{"code":"361","type":"RC"},{"code":"23480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1547.5,"setting":"both","billing_class":"facility"},{"gross_charge":1547.5,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF COLLAR BONE-PhHOS","code_information":[{"code":"2810295","type":"CDM"},{"code":"361","type":"RC"},{"code":"23485","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.5,"setting":"both","billing_class":"facility"},{"gross_charge":1756.5,"setting":"both","billing_class":"professional"}]},{"description":"TX CLAVICLE FX-PhHOS","code_information":[{"code":"2810296","type":"CDM"},{"code":"361","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.5,"setting":"both","billing_class":"facility"},{"gross_charge":426.5,"setting":"both","billing_class":"professional"}]},{"description":"TX CLAVICLE FX-PhHOS","code_information":[{"code":"2810297","type":"CDM"},{"code":"361","type":"RC"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"setting":"both","billing_class":"facility"},{"gross_charge":1366.0,"setting":"both","billing_class":"professional"}]},{"description":"TX CLAVICLE DISLOC-PhHOS","code_information":[{"code":"2810298","type":"CDM"},{"code":"361","type":"RC"},{"code":"23525","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","billing_class":"facility"},{"gross_charge":666.25,"setting":"both","billing_class":"professional"}]},{"description":"TX CLAVICLE DISLOC-PhHOS","code_information":[{"code":"2810299","type":"CDM"},{"code":"361","type":"RC"},{"code":"23550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.25,"setting":"both","billing_class":"facility"},{"gross_charge":1028.25,"setting":"both","billing_class":"professional"}]},{"description":"TX SHOULDER BLADE FX-PhHOS","code_information":[{"code":"2810300","type":"CDM"},{"code":"361","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"setting":"both","billing_class":"facility"},{"gross_charge":458.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810301","type":"CDM"},{"code":"361","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.25,"setting":"both","billing_class":"facility"},{"gross_charge":460.25,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810302","type":"CDM"},{"code":"361","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"setting":"both","billing_class":"facility"},{"gross_charge":811.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810303","type":"CDM"},{"code":"361","type":"RC"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.0,"setting":"both","billing_class":"facility"},{"gross_charge":1675.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810304","type":"CDM"},{"code":"361","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.75,"setting":"both","billing_class":"facility"},{"gross_charge":492.75,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810305","type":"CDM"},{"code":"361","type":"RC"},{"code":"23630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.25,"setting":"both","billing_class":"facility"},{"gross_charge":1436.25,"setting":"both","billing_class":"professional"}]},{"description":"TX SHOULDER DISLOC-PhHOS","code_information":[{"code":"2810306","type":"CDM"},{"code":"361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.75,"setting":"both","billing_class":"facility"},{"gross_charge":538.75,"setting":"both","billing_class":"professional"}]},{"description":"TX SHOULDER DISLOC-PhHOS","code_information":[{"code":"2810307","type":"CDM"},{"code":"361","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.75,"setting":"both","billing_class":"facility"},{"gross_charge":749.75,"setting":"both","billing_class":"professional"}]},{"description":"TX DISLOC/FX-PhHOS","code_information":[{"code":"2810308","type":"CDM"},{"code":"361","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.75,"setting":"both","billing_class":"facility"},{"gross_charge":948.75,"setting":"both","billing_class":"professional"}]},{"description":"FIXATION OF SHOULDER-PhHOS","code_information":[{"code":"2810309","type":"CDM"},{"code":"361","type":"RC"},{"code":"23700","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.5,"setting":"both","billing_class":"facility"},{"gross_charge":370.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN ARM LES-PhHOS","code_information":[{"code":"2810310","type":"CDM"},{"code":"361","type":"RC"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.25,"setting":"both","billing_class":"facility"},{"gross_charge":411.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN ARM BURSA-PhHOS","code_information":[{"code":"2810311","type":"CDM"},{"code":"361","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"REM ARM/ELBOW LES > 3CM-PhHOS","code_information":[{"code":"2810312","type":"CDM"},{"code":"361","type":"RC"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.25,"setting":"both","billing_class":"facility"},{"gross_charge":769.25,"setting":"both","billing_class":"professional"}]},{"description":"EX ARM/ELB TUM > 5CM-PhHOS","code_information":[{"code":"2810313","type":"CDM"},{"code":"361","type":"RC"},{"code":"24073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.75,"setting":"both","billing_class":"facility"},{"gross_charge":1301.75,"setting":"both","billing_class":"professional"}]},{"description":"REM ARM/ELBOW LES < 3CM-PhHOS","code_information":[{"code":"2810314","type":"CDM"},{"code":"361","type":"RC"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.5,"setting":"both","billing_class":"facility"},{"gross_charge":628.5,"setting":"both","billing_class":"professional"}]},{"description":"REM ARM/ELBOW LES-PhHOS","code_information":[{"code":"2810315","type":"CDM"},{"code":"361","type":"RC"},{"code":"24076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.25,"setting":"both","billing_class":"facility"},{"gross_charge":1029.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ELBOW BURSA-PhHOS","code_information":[{"code":"2810316","type":"CDM"},{"code":"361","type":"RC"},{"code":"24105","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.25,"setting":"both","billing_class":"facility"},{"gross_charge":668.25,"setting":"both","billing_class":"professional"}]},{"description":"REM HUMERUS LES-PhHOS","code_information":[{"code":"2810317","type":"CDM"},{"code":"361","type":"RC"},{"code":"24110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"setting":"both","billing_class":"facility"},{"gross_charge":1112.0,"setting":"both","billing_class":"professional"}]},{"description":"REM ELBOW LES-PhHOS","code_information":[{"code":"2810318","type":"CDM"},{"code":"361","type":"RC"},{"code":"24120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.75,"setting":"both","billing_class":"facility"},{"gross_charge":1001.75,"setting":"both","billing_class":"professional"}]},{"description":"RADICAL RESECT ELBOW-PhHOS","code_information":[{"code":"2810319","type":"CDM"},{"code":"361","type":"RC"},{"code":"24149","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.5,"setting":"both","billing_class":"facility"},{"gross_charge":2211.5,"setting":"both","billing_class":"professional"}]},{"description":"REM RADIUS HEAD IMPLANT-PhHOS","code_information":[{"code":"2810320","type":"CDM"},{"code":"361","type":"RC"},{"code":"24164","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"setting":"both","billing_class":"facility"},{"gross_charge":1371.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ARM FB-PhHOS","code_information":[{"code":"2810321","type":"CDM"},{"code":"361","type":"RC"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"facility"},{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ARM FB-PhHOS","code_information":[{"code":"2810322","type":"CDM"},{"code":"361","type":"RC"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.75,"setting":"both","billing_class":"facility"},{"gross_charge":693.75,"setting":"both","billing_class":"professional"}]},{"description":"REP ARM TEND/MSCL-PhHOS","code_information":[{"code":"2810323","type":"CDM"},{"code":"361","type":"RC"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"setting":"both","billing_class":"facility"},{"gross_charge":1420.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF RUPTURED TEND-PhHOS","code_information":[{"code":"2810324","type":"CDM"},{"code":"361","type":"RC"},{"code":"24342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"setting":"both","billing_class":"facility"},{"gross_charge":1427.0,"setting":"both","billing_class":"professional"}]},{"description":"REP ELBOW W/DEB OPEN-PhHOS","code_information":[{"code":"2810325","type":"CDM"},{"code":"361","type":"RC"},{"code":"24358","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.25,"setting":"both","billing_class":"facility"},{"gross_charge":978.25,"setting":"both","billing_class":"professional"}]},{"description":"REP ELBOW DEB/ATTCH OPEN-PhHOS","code_information":[{"code":"2810326","type":"CDM"},{"code":"361","type":"RC"},{"code":"24359","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.5,"setting":"both","billing_class":"facility"},{"gross_charge":1245.5,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTR HEAD OF RADIUS-PhHOS","code_information":[{"code":"2810327","type":"CDM"},{"code":"361","type":"RC"},{"code":"24366","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.75,"setting":"both","billing_class":"facility"},{"gross_charge":1507.75,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810328","type":"CDM"},{"code":"361","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.25,"setting":"both","billing_class":"facility"},{"gross_charge":623.25,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810329","type":"CDM"},{"code":"361","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.0,"setting":"both","billing_class":"facility"},{"gross_charge":862.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810330","type":"CDM"},{"code":"361","type":"RC"},{"code":"24516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"setting":"both","billing_class":"facility"},{"gross_charge":1624.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810331","type":"CDM"},{"code":"361","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"setting":"both","billing_class":"facility"},{"gross_charge":657.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810332","type":"CDM"},{"code":"361","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.25,"setting":"both","billing_class":"facility"},{"gross_charge":1078.25,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810333","type":"CDM"},{"code":"361","type":"RC"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.75,"setting":"both","billing_class":"facility"},{"gross_charge":1407.75,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810334","type":"CDM"},{"code":"361","type":"RC"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.75,"setting":"both","billing_class":"facility"},{"gross_charge":1709.75,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810335","type":"CDM"},{"code":"361","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"setting":"both","billing_class":"facility"},{"gross_charge":553.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS FX-PhHOS","code_information":[{"code":"2810336","type":"CDM"},{"code":"361","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.5,"setting":"both","billing_class":"facility"},{"gross_charge":889.5,"setting":"both","billing_class":"professional"}]},{"description":"TX ELBOW DISLOC-PhHOS","code_information":[{"code":"2810337","type":"CDM"},{"code":"361","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.5,"setting":"both","billing_class":"facility"},{"gross_charge":892.5,"setting":"both","billing_class":"professional"}]},{"description":"TX ELBOW FX-PhHOS","code_information":[{"code":"2810338","type":"CDM"},{"code":"361","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.75,"setting":"both","billing_class":"facility"},{"gross_charge":999.75,"setting":"both","billing_class":"professional"}]},{"description":"TX RADIUS FX-PhHOS","code_information":[{"code":"2810339","type":"CDM"},{"code":"361","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.25,"setting":"both","billing_class":"facility"},{"gross_charge":358.25,"setting":"both","billing_class":"professional"}]},{"description":"TX RADIUS FX-PhHOS","code_information":[{"code":"2810340","type":"CDM"},{"code":"361","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"setting":"both","billing_class":"facility"},{"gross_charge":762.0,"setting":"both","billing_class":"professional"}]},{"description":"TX RADIUS FX-PhHOS","code_information":[{"code":"2810341","type":"CDM"},{"code":"361","type":"RC"},{"code":"24665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"setting":"both","billing_class":"facility"},{"gross_charge":1221.0,"setting":"both","billing_class":"professional"}]},{"description":"TX ULNAR FX-PhHOS","code_information":[{"code":"2810342","type":"CDM"},{"code":"361","type":"RC"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"setting":"both","billing_class":"facility"},{"gross_charge":504.0,"setting":"both","billing_class":"professional"}]},{"description":"TX ULNAR FX-PhHOS","code_information":[{"code":"2810343","type":"CDM"},{"code":"361","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.75,"setting":"both","billing_class":"facility"},{"gross_charge":792.75,"setting":"both","billing_class":"professional"}]},{"description":"TX ULNAR FX-PhHOS","code_information":[{"code":"2810344","type":"CDM"},{"code":"361","type":"RC"},{"code":"24685","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.5,"setting":"both","billing_class":"facility"},{"gross_charge":1241.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION TEND SHEATH-PhHOS","code_information":[{"code":"2810345","type":"CDM"},{"code":"361","type":"RC"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.75,"setting":"both","billing_class":"facility"},{"gross_charge":639.75,"setting":"both","billing_class":"professional"}]},{"description":"DECOMPR FOREARM 1 SPACE-PhHOS","code_information":[{"code":"2810346","type":"CDM"},{"code":"361","type":"RC"},{"code":"25023","type":"HCPCS"}],"standard_charges":[{"gross_charge":2108.5,"setting":"both","billing_class":"facility"},{"gross_charge":2108.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FOREARM LES-PhHOS","code_information":[{"code":"2810347","type":"CDM"},{"code":"361","type":"RC"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.75,"setting":"both","billing_class":"facility"},{"gross_charge":1002.75,"setting":"both","billing_class":"professional"}]},{"description":"BX FOREARM SOFT TISSUES-PhHOS","code_information":[{"code":"2810348","type":"CDM"},{"code":"361","type":"RC"},{"code":"25066","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.5,"setting":"both","billing_class":"facility"},{"gross_charge":678.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM LES SUBC>3CM-PhHOS","code_information":[{"code":"2810349","type":"CDM"},{"code":"361","type":"RC"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.0,"setting":"both","billing_class":"facility"},{"gross_charge":805.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FOREARM TUM DEEP 3CM-PhHOS","code_information":[{"code":"2810350","type":"CDM"},{"code":"361","type":"RC"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.75,"setting":"both","billing_class":"facility"},{"gross_charge":1004.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM LES SUBC<3CM-PhHOS","code_information":[{"code":"2810351","type":"CDM"},{"code":"361","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"setting":"both","billing_class":"facility"},{"gross_charge":604.0,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE/TX WRIST JNT-PhHOS","code_information":[{"code":"2810352","type":"CDM"},{"code":"361","type":"RC"},{"code":"25101","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"setting":"both","billing_class":"facility"},{"gross_charge":753.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TEND FOREARM/WRIST-PhHOS","code_information":[{"code":"2810353","type":"CDM"},{"code":"361","type":"RC"},{"code":"25109","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"setting":"both","billing_class":"facility"},{"gross_charge":1014.0,"setting":"both","billing_class":"professional"}]},{"description":"REM WRIST TEND LES-PhHOS","code_information":[{"code":"2810354","type":"CDM"},{"code":"361","type":"RC"},{"code":"25110","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.75,"setting":"both","billing_class":"facility"},{"gross_charge":643.75,"setting":"both","billing_class":"professional"}]},{"description":"REM WRIST TEND LES-PhHOS","code_information":[{"code":"2810355","type":"CDM"},{"code":"361","type":"RC"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"setting":"both","billing_class":"facility"},{"gross_charge":609.0,"setting":"both","billing_class":"professional"}]},{"description":"REREM WRIST TEND LES-PhHOS","code_information":[{"code":"2810356","type":"CDM"},{"code":"361","type":"RC"},{"code":"25112","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.5,"setting":"both","billing_class":"facility"},{"gross_charge":732.5,"setting":"both","billing_class":"professional"}]},{"description":"REM WRIST/FOREARM LES-PhHOS","code_information":[{"code":"2810357","type":"CDM"},{"code":"361","type":"RC"},{"code":"25116","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.5,"setting":"both","billing_class":"facility"},{"gross_charge":1135.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISE WRIST TEND SHEATH-PhHOS","code_information":[{"code":"2810358","type":"CDM"},{"code":"361","type":"RC"},{"code":"25118","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.25,"setting":"both","billing_class":"facility"},{"gross_charge":721.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOREARM LES-PhHOS","code_information":[{"code":"2810359","type":"CDM"},{"code":"361","type":"RC"},{"code":"25120","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"},{"gross_charge":941.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF ULNA-PhHOS","code_information":[{"code":"2810360","type":"CDM"},{"code":"361","type":"RC"},{"code":"25150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.5,"setting":"both","billing_class":"facility"},{"gross_charge":1037.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM FB-PhHOS","code_information":[{"code":"2810361","type":"CDM"},{"code":"361","type":"RC"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.5,"setting":"both","billing_class":"facility"},{"gross_charge":781.5,"setting":"both","billing_class":"professional"}]},{"description":"REP FOREARM TEND/MSCL-PhHOS","code_information":[{"code":"2810362","type":"CDM"},{"code":"361","type":"RC"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.5,"setting":"both","billing_class":"facility"},{"gross_charge":1192.5,"setting":"both","billing_class":"professional"}]},{"description":"REP FOREARM TEND/MSCL-PhHOS","code_information":[{"code":"2810363","type":"CDM"},{"code":"361","type":"RC"},{"code":"25265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.75,"setting":"both","billing_class":"facility"},{"gross_charge":1411.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FOREARM TEND/MSCL-PhHOS","code_information":[{"code":"2810364","type":"CDM"},{"code":"361","type":"RC"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.25,"setting":"both","billing_class":"facility"},{"gross_charge":927.25,"setting":"both","billing_class":"professional"}]},{"description":"REP FOREARM TEND SHEATH-PhHOS","code_information":[{"code":"2810365","type":"CDM"},{"code":"361","type":"RC"},{"code":"25275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.25,"setting":"both","billing_class":"facility"},{"gross_charge":1229.25,"setting":"both","billing_class":"professional"}]},{"description":"REV WRIST/FOREARM TEND-PhHOS","code_information":[{"code":"2810366","type":"CDM"},{"code":"361","type":"RC"},{"code":"25280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"setting":"both","billing_class":"facility"},{"gross_charge":1063.0,"setting":"both","billing_class":"professional"}]},{"description":"REL WRIST/FOREARM TEND-PhHOS","code_information":[{"code":"2810367","type":"CDM"},{"code":"361","type":"RC"},{"code":"25295","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"setting":"both","billing_class":"facility"},{"gross_charge":957.0,"setting":"both","billing_class":"professional"}]},{"description":"REP RADIUS OR ULNA-PhHOS","code_information":[{"code":"2810368","type":"CDM"},{"code":"361","type":"RC"},{"code":"25400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.75,"setting":"both","billing_class":"facility"},{"gross_charge":1511.75,"setting":"both","billing_class":"professional"}]},{"description":"REP RADIUS & ULNA-PhHOS","code_information":[{"code":"2810369","type":"CDM"},{"code":"361","type":"RC"},{"code":"25415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.75,"setting":"both","billing_class":"facility"},{"gross_charge":1769.75,"setting":"both","billing_class":"professional"}]},{"description":"REP WRIST JNT-PhHOS","code_information":[{"code":"2810370","type":"CDM"},{"code":"361","type":"RC"},{"code":"25447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1557.75,"setting":"both","billing_class":"facility"},{"gross_charge":1557.75,"setting":"both","billing_class":"professional"}]},{"description":"REM WRIST JNT IMPLANT-PhHOS","code_information":[{"code":"2810371","type":"CDM"},{"code":"361","type":"RC"},{"code":"25449","type":"HCPCS"}],"standard_charges":[{"gross_charge":1958.5,"setting":"both","billing_class":"facility"},{"gross_charge":1958.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF RADIUS-PhHOS","code_information":[{"code":"2810372","type":"CDM"},{"code":"361","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"facility"},{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF RADIUS-PhHOS","code_information":[{"code":"2810373","type":"CDM"},{"code":"361","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.25,"setting":"both","billing_class":"facility"},{"gross_charge":877.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF RADIUS-PhHOS","code_information":[{"code":"2810374","type":"CDM"},{"code":"361","type":"RC"},{"code":"25515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"setting":"both","billing_class":"facility"},{"gross_charge":1266.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF RADIUS-PhHOS","code_information":[{"code":"2810375","type":"CDM"},{"code":"361","type":"RC"},{"code":"25525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.25,"setting":"both","billing_class":"facility"},{"gross_charge":1440.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF ULNA-PhHOS","code_information":[{"code":"2810376","type":"CDM"},{"code":"361","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"setting":"both","billing_class":"facility"},{"gross_charge":455.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF ULNA-PhHOS","code_information":[{"code":"2810377","type":"CDM"},{"code":"361","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.75,"setting":"both","billing_class":"facility"},{"gross_charge":851.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FX OF ULNA-PhHOS","code_information":[{"code":"2810378","type":"CDM"},{"code":"361","type":"RC"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1180.25,"setting":"both","billing_class":"facility"},{"gross_charge":1180.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS & ULNA-PhHOS","code_information":[{"code":"2810379","type":"CDM"},{"code":"361","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.5,"setting":"both","billing_class":"facility"},{"gross_charge":375.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS & ULNA-PhHOS","code_information":[{"code":"2810380","type":"CDM"},{"code":"361","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.75,"setting":"both","billing_class":"facility"},{"gross_charge":898.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS & ULNA-PhHOS","code_information":[{"code":"2810381","type":"CDM"},{"code":"361","type":"RC"},{"code":"25574","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.25,"setting":"both","billing_class":"facility"},{"gross_charge":1276.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS/ULNA-PhHOS","code_information":[{"code":"2810382","type":"CDM"},{"code":"361","type":"RC"},{"code":"25575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.5,"setting":"both","billing_class":"facility"},{"gross_charge":1700.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS/ULNA-PhHOS","code_information":[{"code":"2810383","type":"CDM"},{"code":"361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.25,"setting":"both","billing_class":"facility"},{"gross_charge":464.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIUS/ULNA-PhHOS","code_information":[{"code":"2810384","type":"CDM"},{"code":"361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.5,"setting":"both","billing_class":"facility"},{"gross_charge":983.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX DISTAL RADIAL-PhHOS","code_information":[{"code":"2810385","type":"CDM"},{"code":"361","type":"RC"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","billing_class":"facility"},{"gross_charge":1253.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RAD EXRA-ARTICUL-PhHOS","code_information":[{"code":"2810386","type":"CDM"},{"code":"361","type":"RC"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.5,"setting":"both","billing_class":"facility"},{"gross_charge":1391.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RAD INTRA-ARTICUL-PhHOS","code_information":[{"code":"2810387","type":"CDM"},{"code":"361","type":"RC"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.5,"setting":"both","billing_class":"facility"},{"gross_charge":1555.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FX RADIAL 3 FRAG-PhHOS","code_information":[{"code":"2810388","type":"CDM"},{"code":"361","type":"RC"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":1974.75,"setting":"both","billing_class":"facility"},{"gross_charge":1974.75,"setting":"both","billing_class":"professional"}]},{"description":"TX WRIST BONE FX-PhHOS","code_information":[{"code":"2810389","type":"CDM"},{"code":"361","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.25,"setting":"both","billing_class":"facility"},{"gross_charge":414.25,"setting":"both","billing_class":"professional"}]},{"description":"TX WRIST BONE FX-PhHOS","code_information":[{"code":"2810390","type":"CDM"},{"code":"361","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.5,"setting":"both","billing_class":"facility"},{"gross_charge":534.5,"setting":"both","billing_class":"professional"}]},{"description":"TX WRIST BONE FX-PhHOS","code_information":[{"code":"2810391","type":"CDM"},{"code":"361","type":"RC"},{"code":"25645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.25,"setting":"both","billing_class":"facility"},{"gross_charge":1076.25,"setting":"both","billing_class":"professional"}]},{"description":"PIN ULNAR STYLOID FX-PhHOS","code_information":[{"code":"2810392","type":"CDM"},{"code":"361","type":"RC"},{"code":"25651","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.25,"setting":"both","billing_class":"facility"},{"gross_charge":919.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FX ULNAR STYLOID-PhHOS","code_information":[{"code":"2810393","type":"CDM"},{"code":"361","type":"RC"},{"code":"25652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.25,"setting":"both","billing_class":"facility"},{"gross_charge":1175.25,"setting":"both","billing_class":"professional"}]},{"description":"PIN RADIOULNAR DISLOC-PhHOS","code_information":[{"code":"2810394","type":"CDM"},{"code":"361","type":"RC"},{"code":"25671","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.75,"setting":"both","billing_class":"facility"},{"gross_charge":1006.75,"setting":"both","billing_class":"professional"}]},{"description":"TX WRIST DISLOC-PhHOS","code_information":[{"code":"2810395","type":"CDM"},{"code":"361","type":"RC"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.25,"setting":"both","billing_class":"facility"},{"gross_charge":771.25,"setting":"both","billing_class":"professional"}]},{"description":"TX WRIST DISLOC-PhHOS","code_information":[{"code":"2810396","type":"CDM"},{"code":"361","type":"RC"},{"code":"25676","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.75,"setting":"both","billing_class":"facility"},{"gross_charge":1148.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSCESS-PhHOS","code_information":[{"code":"2810397","type":"CDM"},{"code":"361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":251.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSCESS-PhHOS","code_information":[{"code":"2810398","type":"CDM"},{"code":"361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"setting":"both","billing_class":"facility"},{"gross_charge":351.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN HAND TEND SHEATH-PhHOS","code_information":[{"code":"2810399","type":"CDM"},{"code":"361","type":"RC"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.75,"setting":"both","billing_class":"facility"},{"gross_charge":799.75,"setting":"both","billing_class":"professional"}]},{"description":"TX HAND BONE LES-PhHOS","code_information":[{"code":"2810400","type":"CDM"},{"code":"361","type":"RC"},{"code":"26034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.25,"setting":"both","billing_class":"facility"},{"gross_charge":1021.25,"setting":"both","billing_class":"professional"}]},{"description":"DECOMPR FINGERS/HAND-PhHOS","code_information":[{"code":"2810401","type":"CDM"},{"code":"361","type":"RC"},{"code":"26037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.25,"setting":"both","billing_class":"facility"},{"gross_charge":1078.25,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE PALM CONTRACTURE-PhHOS","code_information":[{"code":"2810402","type":"CDM"},{"code":"361","type":"RC"},{"code":"26045","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.25,"setting":"both","billing_class":"facility"},{"gross_charge":874.25,"setting":"both","billing_class":"professional"}]},{"description":"INC FINGER TEND SHEATH-PhHOS","code_information":[{"code":"2810403","type":"CDM"},{"code":"361","type":"RC"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.75,"setting":"both","billing_class":"facility"},{"gross_charge":590.75,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE/TX FINGER JNT-PhHOS","code_information":[{"code":"2810404","type":"CDM"},{"code":"361","type":"RC"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.5,"setting":"both","billing_class":"facility"},{"gross_charge":738.5,"setting":"both","billing_class":"professional"}]},{"description":"EX HAND LES SC > 1.5CM-PhHOS","code_information":[{"code":"2810405","type":"CDM"},{"code":"361","type":"RC"},{"code":"26111","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.5,"setting":"both","billing_class":"facility"},{"gross_charge":788.5,"setting":"both","billing_class":"professional"}]},{"description":"REM HAND LES SUBCUT-PhHOS","code_information":[{"code":"2810406","type":"CDM"},{"code":"361","type":"RC"},{"code":"26115","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.5,"setting":"both","billing_class":"facility"},{"gross_charge":629.5,"setting":"both","billing_class":"professional"}]},{"description":"REM HAND LES DEEP-PhHOS","code_information":[{"code":"2810407","type":"CDM"},{"code":"361","type":"RC"},{"code":"26116","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.5,"setting":"both","billing_class":"facility"},{"gross_charge":993.5,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE PALM CONTRACTURE-PhHOS","code_information":[{"code":"2810408","type":"CDM"},{"code":"361","type":"RC"},{"code":"26121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1126.25,"setting":"both","billing_class":"facility"},{"gross_charge":1126.25,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE PALM CONTRACTURE-PhHOS","code_information":[{"code":"2810409","type":"CDM"},{"code":"361","type":"RC"},{"code":"26123","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"setting":"both","billing_class":"facility"},{"gross_charge":1570.0,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE PALM CONTRACTURE-PhHOS","code_information":[{"code":"2810410","type":"CDM"},{"code":"361","type":"RC"},{"code":"26125","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.25,"setting":"both","billing_class":"facility"},{"gross_charge":511.25,"setting":"both","billing_class":"professional"}]},{"description":"TEND EX PALM/FINGER-PhHOS","code_information":[{"code":"2810411","type":"CDM"},{"code":"361","type":"RC"},{"code":"26145","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"setting":"both","billing_class":"facility"},{"gross_charge":966.0,"setting":"both","billing_class":"professional"}]},{"description":"REM TEND SHEATH LES-PhHOS","code_information":[{"code":"2810412","type":"CDM"},{"code":"361","type":"RC"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.5,"setting":"both","billing_class":"facility"},{"gross_charge":634.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FINGER TEND-PhHOS","code_information":[{"code":"2810413","type":"CDM"},{"code":"361","type":"RC"},{"code":"26180","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"facility"},{"gross_charge":836.5,"setting":"both","billing_class":"professional"}]},{"description":"REM HAND BONE LES-PhHOS","code_information":[{"code":"2810414","type":"CDM"},{"code":"361","type":"RC"},{"code":"26200","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.75,"setting":"both","billing_class":"facility"},{"gross_charge":849.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FINGER LES-PhHOS","code_information":[{"code":"2810415","type":"CDM"},{"code":"361","type":"RC"},{"code":"26210","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.5,"setting":"both","billing_class":"facility"},{"gross_charge":835.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM FINGER BONE-PhHOS","code_information":[{"code":"2810416","type":"CDM"},{"code":"361","type":"RC"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.5,"setting":"both","billing_class":"facility"},{"gross_charge":832.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF IMPLANT FROM HAND-PhHOS","code_information":[{"code":"2810417","type":"CDM"},{"code":"361","type":"RC"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"setting":"both","billing_class":"facility"},{"gross_charge":655.0,"setting":"both","billing_class":"professional"}]},{"description":"REP HAND TEND-PhHOS","code_information":[{"code":"2810418","type":"CDM"},{"code":"361","type":"RC"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"setting":"both","billing_class":"facility"},{"gross_charge":1071.0,"setting":"both","billing_class":"professional"}]},{"description":"REP FINGER TEND-PhHOS","code_information":[{"code":"2810419","type":"CDM"},{"code":"361","type":"RC"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.75,"setting":"both","billing_class":"facility"},{"gross_charge":1100.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FINGER/HAND TEND-PhHOS","code_information":[{"code":"2810420","type":"CDM"},{"code":"361","type":"RC"},{"code":"26426","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.75,"setting":"both","billing_class":"facility"},{"gross_charge":945.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FINGER TEND-PhHOS","code_information":[{"code":"2810421","type":"CDM"},{"code":"361","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.75,"setting":"both","billing_class":"facility"},{"gross_charge":945.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FINGER TEND-PhHOS","code_information":[{"code":"2810422","type":"CDM"},{"code":"361","type":"RC"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.25,"setting":"both","billing_class":"facility"},{"gross_charge":974.25,"setting":"both","billing_class":"professional"}]},{"description":"REALIGNMENT OF TENDS-PhHOS","code_information":[{"code":"2810423","type":"CDM"},{"code":"361","type":"RC"},{"code":"26437","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"setting":"both","billing_class":"facility"},{"gross_charge":1172.0,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE PALM/FINGER TEND-PhHOS","code_information":[{"code":"2810424","type":"CDM"},{"code":"361","type":"RC"},{"code":"26440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"setting":"both","billing_class":"facility"},{"gross_charge":1120.0,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE HAND/FINGER TEND-PhHOS","code_information":[{"code":"2810425","type":"CDM"},{"code":"361","type":"RC"},{"code":"26445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.5,"setting":"both","billing_class":"facility"},{"gross_charge":1093.5,"setting":"both","billing_class":"professional"}]},{"description":"TEND SHORTENING-PhHOS","code_information":[{"code":"2810426","type":"CDM"},{"code":"361","type":"RC"},{"code":"26477","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.5,"setting":"both","billing_class":"facility"},{"gross_charge":1096.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANSPLANT HAND TEND-PhHOS","code_information":[{"code":"2810427","type":"CDM"},{"code":"361","type":"RC"},{"code":"26480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.0,"setting":"both","billing_class":"facility"},{"gross_charge":1422.0,"setting":"both","billing_class":"professional"}]},{"description":"REL FINGER CONTRACTURE-PhHOS","code_information":[{"code":"2810428","type":"CDM"},{"code":"361","type":"RC"},{"code":"26525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.25,"setting":"both","billing_class":"facility"},{"gross_charge":1234.25,"setting":"both","billing_class":"professional"}]},{"description":"REP HAND JNT-PhHOS","code_information":[{"code":"2810429","type":"CDM"},{"code":"361","type":"RC"},{"code":"26540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.5,"setting":"both","billing_class":"facility"},{"gross_charge":1239.5,"setting":"both","billing_class":"professional"}]},{"description":"REP NONUNION HAND-PhHOS","code_information":[{"code":"2810430","type":"CDM"},{"code":"361","type":"RC"},{"code":"26546","type":"HCPCS"}],"standard_charges":[{"gross_charge":1868.75,"setting":"both","billing_class":"facility"},{"gross_charge":1868.75,"setting":"both","billing_class":"professional"}]},{"description":"TX METACARPAL FX-PhHOS","code_information":[{"code":"2810431","type":"CDM"},{"code":"361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.25,"setting":"both","billing_class":"facility"},{"gross_charge":414.25,"setting":"both","billing_class":"professional"}]},{"description":"TX METACARPAL FX-PhHOS","code_information":[{"code":"2810432","type":"CDM"},{"code":"361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"setting":"both","billing_class":"facility"},{"gross_charge":561.0,"setting":"both","billing_class":"professional"}]},{"description":"TX METACARPAL FX-PhHOS","code_information":[{"code":"2810433","type":"CDM"},{"code":"361","type":"RC"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.75,"setting":"both","billing_class":"facility"},{"gross_charge":903.75,"setting":"both","billing_class":"professional"}]},{"description":"TX METACARPAL FX-PhHOS","code_information":[{"code":"2810434","type":"CDM"},{"code":"361","type":"RC"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.5,"setting":"both","billing_class":"facility"},{"gross_charge":1090.5,"setting":"both","billing_class":"professional"}]},{"description":"TX THUMB DISLOC-PhHOS","code_information":[{"code":"2810435","type":"CDM"},{"code":"361","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.75,"setting":"both","billing_class":"facility"},{"gross_charge":638.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THUMB FX-PhHOS","code_information":[{"code":"2810436","type":"CDM"},{"code":"361","type":"RC"},{"code":"26650","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"setting":"both","billing_class":"facility"},{"gross_charge":906.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HAND DISLOC-PhHOS","code_information":[{"code":"2810437","type":"CDM"},{"code":"361","type":"RC"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.75,"setting":"both","billing_class":"facility"},{"gross_charge":792.75,"setting":"both","billing_class":"professional"}]},{"description":"TX KNUCKLE DISLOC-PhHOS","code_information":[{"code":"2810438","type":"CDM"},{"code":"361","type":"RC"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.25,"setting":"both","billing_class":"facility"},{"gross_charge":722.25,"setting":"both","billing_class":"professional"}]},{"description":"TX KNUCKLE DISLOC-PhHOS","code_information":[{"code":"2810439","type":"CDM"},{"code":"361","type":"RC"},{"code":"26715","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"setting":"both","billing_class":"facility"},{"gross_charge":1068.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810440","type":"CDM"},{"code":"361","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"setting":"both","billing_class":"facility"},{"gross_charge":355.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810441","type":"CDM"},{"code":"361","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.5,"setting":"both","billing_class":"facility"},{"gross_charge":579.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810442","type":"CDM"},{"code":"361","type":"RC"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.5,"setting":"both","billing_class":"facility"},{"gross_charge":888.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810443","type":"CDM"},{"code":"361","type":"RC"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.25,"setting":"both","billing_class":"facility"},{"gross_charge":1129.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810444","type":"CDM"},{"code":"361","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.25,"setting":"both","billing_class":"facility"},{"gross_charge":411.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810445","type":"CDM"},{"code":"361","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"setting":"both","billing_class":"facility"},{"gross_charge":610.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810446","type":"CDM"},{"code":"361","type":"RC"},{"code":"26746","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.5,"setting":"both","billing_class":"facility"},{"gross_charge":1397.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810447","type":"CDM"},{"code":"361","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"setting":"both","billing_class":"facility"},{"gross_charge":355.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810448","type":"CDM"},{"code":"361","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.25,"setting":"both","billing_class":"facility"},{"gross_charge":522.25,"setting":"both","billing_class":"professional"}]},{"description":"PIN FINGER FX EACH-PhHOS","code_information":[{"code":"2810449","type":"CDM"},{"code":"361","type":"RC"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.25,"setting":"both","billing_class":"facility"},{"gross_charge":776.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EACH-PhHOS","code_information":[{"code":"2810450","type":"CDM"},{"code":"361","type":"RC"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.75,"setting":"both","billing_class":"facility"},{"gross_charge":951.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER DISLOC-PhHOS","code_information":[{"code":"2810451","type":"CDM"},{"code":"361","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.5,"setting":"both","billing_class":"facility"},{"gross_charge":630.5,"setting":"both","billing_class":"professional"}]},{"description":"PIN FINGER DISLOC-PhHOS","code_information":[{"code":"2810452","type":"CDM"},{"code":"361","type":"RC"},{"code":"26776","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.5,"setting":"both","billing_class":"facility"},{"gross_charge":838.5,"setting":"both","billing_class":"professional"}]},{"description":"FUSION OF KNUCKLE-PhHOS","code_information":[{"code":"2810453","type":"CDM"},{"code":"361","type":"RC"},{"code":"26850","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.5,"setting":"both","billing_class":"facility"},{"gross_charge":1299.5,"setting":"both","billing_class":"professional"}]},{"description":"FUSION OF KNUCKLE W GRFT-PhHOS","code_information":[{"code":"2810454","type":"CDM"},{"code":"361","type":"RC"},{"code":"26852","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.25,"setting":"both","billing_class":"facility"},{"gross_charge":1487.25,"setting":"both","billing_class":"professional"}]},{"description":"FUSION OF FINGER JNT-PhHOS","code_information":[{"code":"2810455","type":"CDM"},{"code":"361","type":"RC"},{"code":"26860","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"setting":"both","billing_class":"facility"},{"gross_charge":1064.0,"setting":"both","billing_class":"professional"}]},{"description":"FUSION FINGER JNT ADDL-PhHOS","code_information":[{"code":"2810456","type":"CDM"},{"code":"361","type":"RC"},{"code":"26861","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"facility"},{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE METACARPAL BONE-PhHOS","code_information":[{"code":"2810457","type":"CDM"},{"code":"361","type":"RC"},{"code":"26910","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.5,"setting":"both","billing_class":"facility"},{"gross_charge":1346.5,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE FINGER/THUMB-PhHOS","code_information":[{"code":"2810458","type":"CDM"},{"code":"361","type":"RC"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.25,"setting":"both","billing_class":"facility"},{"gross_charge":1235.25,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE FINGER/THUMB-PhHOS","code_information":[{"code":"2810459","type":"CDM"},{"code":"361","type":"RC"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"setting":"both","billing_class":"facility"},{"gross_charge":1215.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PELVIS LES-PhHOS","code_information":[{"code":"2810460","type":"CDM"},{"code":"361","type":"RC"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.5,"setting":"both","billing_class":"facility"},{"gross_charge":1186.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN HIP JNT-PhHOS","code_information":[{"code":"2810461","type":"CDM"},{"code":"361","type":"RC"},{"code":"27030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.5,"setting":"both","billing_class":"facility"},{"gross_charge":1706.5,"setting":"both","billing_class":"professional"}]},{"description":"EX HIP/PELV LES SC >3CM-PhHOS","code_information":[{"code":"2810462","type":"CDM"},{"code":"361","type":"RC"},{"code":"27043","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.5,"setting":"both","billing_class":"facility"},{"gross_charge":890.5,"setting":"both","billing_class":"professional"}]},{"description":"EX HIP/PELV TUM >5CM-PhHOS","code_information":[{"code":"2810463","type":"CDM"},{"code":"361","type":"RC"},{"code":"27045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.75,"setting":"both","billing_class":"facility"},{"gross_charge":1405.75,"setting":"both","billing_class":"professional"}]},{"description":"REM HIP/PELVIS LES <3CM-PhHOS","code_information":[{"code":"2810464","type":"CDM"},{"code":"361","type":"RC"},{"code":"27047","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.75,"setting":"both","billing_class":"facility"},{"gross_charge":689.75,"setting":"both","billing_class":"professional"}]},{"description":"REM HIP/PELVIS LES >3CM-PhHOS","code_information":[{"code":"2810465","type":"CDM"},{"code":"361","type":"RC"},{"code":"27048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1132.25,"setting":"both","billing_class":"facility"},{"gross_charge":1132.25,"setting":"both","billing_class":"professional"}]},{"description":"BUTTOCK FASCIOT W/DBRDMT-PhHOS","code_information":[{"code":"2810466","type":"CDM"},{"code":"361","type":"RC"},{"code":"27057","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.5,"setting":"both","billing_class":"facility"},{"gross_charge":1911.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF HIP PROSTHESIS-PhHOS","code_information":[{"code":"2810467","type":"CDM"},{"code":"361","type":"RC"},{"code":"27091","type":"HCPCS"}],"standard_charges":[{"gross_charge":2948.0,"setting":"both","billing_class":"facility"},{"gross_charge":2948.0,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL HIP ARTHROPLASTY-PhHOS","code_information":[{"code":"2810468","type":"CDM"},{"code":"361","type":"RC"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.25,"setting":"both","billing_class":"facility"},{"gross_charge":2967.25,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL HIP ARTHROPLASTY-PhHOS","code_information":[{"code":"2810469","type":"CDM"},{"code":"361","type":"RC"},{"code":"27132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"setting":"both","billing_class":"facility"},{"gross_charge":3158.0,"setting":"both","billing_class":"professional"}]},{"description":"REV HIP JNT REPLACEMENT-PhHOS","code_information":[{"code":"2810470","type":"CDM"},{"code":"361","type":"RC"},{"code":"27134","type":"HCPCS"}],"standard_charges":[{"gross_charge":3940.5,"setting":"both","billing_class":"facility"},{"gross_charge":3940.5,"setting":"both","billing_class":"professional"}]},{"description":"REV HIP JNT REPLACEMENT-PhHOS","code_information":[{"code":"2810471","type":"CDM"},{"code":"361","type":"RC"},{"code":"27137","type":"HCPCS"}],"standard_charges":[{"gross_charge":2779.5,"setting":"both","billing_class":"facility"},{"gross_charge":2779.5,"setting":"both","billing_class":"professional"}]},{"description":"REV HIP JNT REPLACEMENT-PhHOS","code_information":[{"code":"2810472","type":"CDM"},{"code":"361","type":"RC"},{"code":"27138","type":"HCPCS"}],"standard_charges":[{"gross_charge":2890.75,"setting":"both","billing_class":"facility"},{"gross_charge":2890.75,"setting":"both","billing_class":"professional"}]},{"description":"TX TAIL BONE FX-PhHOS","code_information":[{"code":"2810474","type":"CDM"},{"code":"361","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.75,"setting":"both","billing_class":"facility"},{"gross_charge":343.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810475","type":"CDM"},{"code":"361","type":"RC"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.5,"setting":"both","billing_class":"facility"},{"gross_charge":881.5,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810476","type":"CDM"},{"code":"361","type":"RC"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.75,"setting":"both","billing_class":"facility"},{"gross_charge":1769.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810477","type":"CDM"},{"code":"361","type":"RC"},{"code":"27236","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.5,"setting":"both","billing_class":"facility"},{"gross_charge":2464.5,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810478","type":"CDM"},{"code":"361","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.75,"setting":"both","billing_class":"facility"},{"gross_charge":843.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810479","type":"CDM"},{"code":"361","type":"RC"},{"code":"27244","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.75,"setting":"both","billing_class":"facility"},{"gross_charge":2534.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810480","type":"CDM"},{"code":"361","type":"RC"},{"code":"27245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2324.75,"setting":"both","billing_class":"facility"},{"gross_charge":2324.75,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810481","type":"CDM"},{"code":"361","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"setting":"both","billing_class":"facility"},{"gross_charge":708.0,"setting":"both","billing_class":"professional"}]},{"description":"TX THIGH FX-PhHOS","code_information":[{"code":"2810482","type":"CDM"},{"code":"361","type":"RC"},{"code":"27248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.5,"setting":"both","billing_class":"facility"},{"gross_charge":1399.5,"setting":"both","billing_class":"professional"}]},{"description":"TX HIP DISLOC-PhHOS","code_information":[{"code":"2810483","type":"CDM"},{"code":"361","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.0,"setting":"both","billing_class":"facility"},{"gross_charge":1435.25,"setting":"both","billing_class":"professional"}]},{"description":"TX HIP DISLOC-PhHOS","code_information":[{"code":"2810484","type":"CDM"},{"code":"361","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.75,"setting":"both","billing_class":"facility"},{"gross_charge":1099.75,"setting":"both","billing_class":"professional"}]},{"description":"OPTX THIGH FX-PhHOS","code_information":[{"code":"2810485","type":"CDM"},{"code":"361","type":"RC"},{"code":"27269","type":"HCPCS"}],"standard_charges":[{"gross_charge":2342.0,"setting":"both","billing_class":"facility"},{"gross_charge":2342.0,"setting":"both","billing_class":"professional"}]},{"description":"MANIPULATION OF HIP JNT-PhHOS","code_information":[{"code":"2810486","type":"CDM"},{"code":"361","type":"RC"},{"code":"27275","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.75,"setting":"both","billing_class":"facility"},{"gross_charge":342.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN THIGH/KNEE LES-PhHOS","code_information":[{"code":"2810487","type":"CDM"},{"code":"361","type":"RC"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.75,"setting":"both","billing_class":"facility"},{"gross_charge":950.75,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORATION OF KNEE JNT-PhHOS","code_information":[{"code":"2810488","type":"CDM"},{"code":"361","type":"RC"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.25,"setting":"both","billing_class":"facility"},{"gross_charge":1383.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES < 3CM-PhHOS","code_information":[{"code":"2810489","type":"CDM"},{"code":"361","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.75,"setting":"both","billing_class":"facility"},{"gross_charge":595.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES-PhHOS","code_information":[{"code":"2810490","type":"CDM"},{"code":"361","type":"RC"},{"code":"27328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.25,"setting":"both","billing_class":"facility"},{"gross_charge":1179.25,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE/TX KNEE JNT-PhHOS","code_information":[{"code":"2810491","type":"CDM"},{"code":"361","type":"RC"},{"code":"27331","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.75,"setting":"both","billing_class":"facility"},{"gross_charge":903.75,"setting":"both","billing_class":"professional"}]},{"description":"REM KNEE JNT LINING-PhHOS","code_information":[{"code":"2810492","type":"CDM"},{"code":"361","type":"RC"},{"code":"27334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.5,"setting":"both","billing_class":"facility"},{"gross_charge":1296.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES > 3CM-PhHOS","code_information":[{"code":"2810493","type":"CDM"},{"code":"361","type":"RC"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.75,"setting":"both","billing_class":"facility"},{"gross_charge":794.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TH/KNEE TUM DEEP >5CM-PhHOS","code_information":[{"code":"2810494","type":"CDM"},{"code":"361","type":"RC"},{"code":"27339","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"setting":"both","billing_class":"facility"},{"gross_charge":1419.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF KNEECAP BURSA-PhHOS","code_information":[{"code":"2810495","type":"CDM"},{"code":"361","type":"RC"},{"code":"27340","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"setting":"both","billing_class":"facility"},{"gross_charge":708.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF KNEECAP-PhHOS","code_information":[{"code":"2810496","type":"CDM"},{"code":"361","type":"RC"},{"code":"27350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.25,"setting":"both","billing_class":"facility"},{"gross_charge":1236.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FEMUR LES-PhHOS","code_information":[{"code":"2810497","type":"CDM"},{"code":"361","type":"RC"},{"code":"27355","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.5,"setting":"both","billing_class":"facility"},{"gross_charge":1141.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FB-PhHOS","code_information":[{"code":"2810498","type":"CDM"},{"code":"361","type":"RC"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.25,"setting":"both","billing_class":"facility"},{"gross_charge":768.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF KNEECAP TEND-PhHOS","code_information":[{"code":"2810499","type":"CDM"},{"code":"361","type":"RC"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.25,"setting":"both","billing_class":"facility"},{"gross_charge":1129.25,"setting":"both","billing_class":"professional"}]},{"description":"REP/GRFT KNEECAP TEND-PhHOS","code_information":[{"code":"2810500","type":"CDM"},{"code":"361","type":"RC"},{"code":"27381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.75,"setting":"both","billing_class":"facility"},{"gross_charge":1462.75,"setting":"both","billing_class":"professional"}]},{"description":"REP OF THIGH MSCL-PhHOS","code_information":[{"code":"2810501","type":"CDM"},{"code":"361","type":"RC"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.5,"setting":"both","billing_class":"facility"},{"gross_charge":1096.5,"setting":"both","billing_class":"professional"}]},{"description":"REV UNSTABLE KNEECAP-PhHOS","code_information":[{"code":"2810502","type":"CDM"},{"code":"361","type":"RC"},{"code":"27422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.5,"setting":"both","billing_class":"facility"},{"gross_charge":1395.5,"setting":"both","billing_class":"professional"}]},{"description":"REV KNEECAP WITH IMPLANT-PhHOS","code_information":[{"code":"2810503","type":"CDM"},{"code":"361","type":"RC"},{"code":"27438","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"setting":"both","billing_class":"facility"},{"gross_charge":1576.0,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL KNEE ARTHROPLASTY-PhHOS","code_information":[{"code":"2810504","type":"CDM"},{"code":"361","type":"RC"},{"code":"27447","type":"HCPCS"}],"standard_charges":[{"gross_charge":3168.25,"setting":"both","billing_class":"facility"},{"gross_charge":3168.25,"setting":"both","billing_class":"professional"}]},{"description":"REV/REPLACE KNEE JNT-PhHOS","code_information":[{"code":"2810505","type":"CDM"},{"code":"361","type":"RC"},{"code":"27486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2658.25,"setting":"both","billing_class":"facility"},{"gross_charge":2658.25,"setting":"both","billing_class":"professional"}]},{"description":"REV/REPLACE KNEE JNT-PhHOS","code_information":[{"code":"2810506","type":"CDM"},{"code":"361","type":"RC"},{"code":"27487","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.0,"setting":"both","billing_class":"facility"},{"gross_charge":3620.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF KNEE PROSTHESIS-PhHOS","code_information":[{"code":"2810507","type":"CDM"},{"code":"361","type":"RC"},{"code":"27488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2271.75,"setting":"both","billing_class":"facility"},{"gross_charge":2271.75,"setting":"both","billing_class":"professional"}]},{"description":"REINFORCE THIGH-PhHOS","code_information":[{"code":"2810508","type":"CDM"},{"code":"361","type":"RC"},{"code":"27495","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"setting":"both","billing_class":"facility"},{"gross_charge":2131.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810509","type":"CDM"},{"code":"361","type":"RC"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"setting":"both","billing_class":"facility"},{"gross_charge":906.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810510","type":"CDM"},{"code":"361","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.75,"setting":"both","billing_class":"facility"},{"gross_charge":946.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810511","type":"CDM"},{"code":"361","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.75,"setting":"both","billing_class":"facility"},{"gross_charge":1456.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810512","type":"CDM"},{"code":"361","type":"RC"},{"code":"27506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2757.25,"setting":"both","billing_class":"facility"},{"gross_charge":2757.25,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810513","type":"CDM"},{"code":"361","type":"RC"},{"code":"27507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"facility"},{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810514","type":"CDM"},{"code":"361","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.5,"setting":"both","billing_class":"facility"},{"gross_charge":940.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810515","type":"CDM"},{"code":"361","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.5,"setting":"both","billing_class":"facility"},{"gross_charge":1298.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810516","type":"CDM"},{"code":"361","type":"RC"},{"code":"27511","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"setting":"both","billing_class":"facility"},{"gross_charge":1880.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810517","type":"CDM"},{"code":"361","type":"RC"},{"code":"27513","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.0,"setting":"both","billing_class":"facility"},{"gross_charge":2338.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF THIGH FX-PhHOS","code_information":[{"code":"2810518","type":"CDM"},{"code":"361","type":"RC"},{"code":"27514","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.0,"setting":"both","billing_class":"facility"},{"gross_charge":1824.0,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEECAP FX-PhHOS","code_information":[{"code":"2810519","type":"CDM"},{"code":"361","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.25,"setting":"both","billing_class":"facility"},{"gross_charge":567.25,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEECAP FX-PhHOS","code_information":[{"code":"2810520","type":"CDM"},{"code":"361","type":"RC"},{"code":"27524","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.5,"setting":"both","billing_class":"facility"},{"gross_charge":1554.5,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE FX-PhHOS","code_information":[{"code":"2810521","type":"CDM"},{"code":"361","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.75,"setting":"both","billing_class":"facility"},{"gross_charge":538.75,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE FX-PhHOS","code_information":[{"code":"2810522","type":"CDM"},{"code":"361","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.5,"setting":"both","billing_class":"facility"},{"gross_charge":1093.5,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE FX-PhHOS","code_information":[{"code":"2810523","type":"CDM"},{"code":"361","type":"RC"},{"code":"27535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1693.25,"setting":"both","billing_class":"facility"},{"gross_charge":1693.25,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE FX-PhHOS","code_information":[{"code":"2810524","type":"CDM"},{"code":"361","type":"RC"},{"code":"27536","type":"HCPCS"}],"standard_charges":[{"gross_charge":2248.25,"setting":"both","billing_class":"facility"},{"gross_charge":2248.25,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE FX-PhHOS","code_information":[{"code":"2810525","type":"CDM"},{"code":"361","type":"RC"},{"code":"27540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1533.25,"setting":"both","billing_class":"facility"},{"gross_charge":1533.25,"setting":"both","billing_class":"professional"}]},{"description":"TX KNEE DISLOC-PhHOS","code_information":[{"code":"2810526","type":"CDM"},{"code":"361","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.5,"setting":"both","billing_class":"facility"},{"gross_charge":1188.5,"setting":"both","billing_class":"professional"}]},{"description":"FIXATION OF KNEE JNT-PhHOS","code_information":[{"code":"2810527","type":"CDM"},{"code":"361","type":"RC"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.75,"setting":"both","billing_class":"facility"},{"gross_charge":289.75,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE LEG AT THIGH-PhHOS","code_information":[{"code":"2810528","type":"CDM"},{"code":"361","type":"RC"},{"code":"27590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1547.5,"setting":"both","billing_class":"facility"},{"gross_charge":1547.5,"setting":"both","billing_class":"professional"}]},{"description":"DECOMPRION OF LOWER LEG-PhHOS","code_information":[{"code":"2810529","type":"CDM"},{"code":"361","type":"RC"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.75,"setting":"both","billing_class":"facility"},{"gross_charge":792.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN LOWER LEG LES-PhHOS","code_information":[{"code":"2810530","type":"CDM"},{"code":"361","type":"RC"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.75,"setting":"both","billing_class":"facility"},{"gross_charge":746.75,"setting":"both","billing_class":"professional"}]},{"description":"BX LOWER LEG SOFT TISSUE-PhHOS","code_information":[{"code":"2810531","type":"CDM"},{"code":"361","type":"RC"},{"code":"27614","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.25,"setting":"both","billing_class":"facility"},{"gross_charge":777.25,"setting":"both","billing_class":"professional"}]},{"description":"REM LOWER LEG LES < 3CM-PhHOS","code_information":[{"code":"2810532","type":"CDM"},{"code":"361","type":"RC"},{"code":"27618","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.5,"setting":"both","billing_class":"professional"}]},{"description":"REM ANKLE JNT LINING-PhHOS","code_information":[{"code":"2810533","type":"CDM"},{"code":"361","type":"RC"},{"code":"27626","type":"HCPCS"}],"standard_charges":[{"gross_charge":1157.75,"setting":"both","billing_class":"facility"},{"gross_charge":1157.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TEND LES-PhHOS","code_information":[{"code":"2810534","type":"CDM"},{"code":"361","type":"RC"},{"code":"27630","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.75,"setting":"both","billing_class":"facility"},{"gross_charge":694.75,"setting":"both","billing_class":"professional"}]},{"description":"EX LEG/ANKLE LES SC>3CM-PhHOS","code_information":[{"code":"2810535","type":"CDM"},{"code":"361","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.5,"setting":"both","billing_class":"facility"},{"gross_charge":789.5,"setting":"both","billing_class":"professional"}]},{"description":"EX LG/ANK TUM DEEP >5CM-PhHOS","code_information":[{"code":"2810536","type":"CDM"},{"code":"361","type":"RC"},{"code":"27634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.5,"setting":"both","billing_class":"facility"},{"gross_charge":1291.5,"setting":"both","billing_class":"professional"}]},{"description":"REM LOWER LEG BONE LES-PhHOS","code_information":[{"code":"2810537","type":"CDM"},{"code":"361","type":"RC"},{"code":"27635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"setting":"both","billing_class":"facility"},{"gross_charge":1117.0,"setting":"both","billing_class":"professional"}]},{"description":"REP ACHILLES TEND-PhHOS","code_information":[{"code":"2810538","type":"CDM"},{"code":"361","type":"RC"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.25,"setting":"both","billing_class":"facility"},{"gross_charge":1379.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF LEG TEND EACH-PhHOS","code_information":[{"code":"2810539","type":"CDM"},{"code":"361","type":"RC"},{"code":"27658","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.25,"setting":"both","billing_class":"facility"},{"gross_charge":719.25,"setting":"both","billing_class":"professional"}]},{"description":"REP LOWER LEG TENDS-PhHOS","code_information":[{"code":"2810540","type":"CDM"},{"code":"361","type":"RC"},{"code":"27675","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.25,"setting":"both","billing_class":"facility"},{"gross_charge":930.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF ANKLE LIGAM-PhHOS","code_information":[{"code":"2810541","type":"CDM"},{"code":"361","type":"RC"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"setting":"both","billing_class":"facility"},{"gross_charge":915.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF TIBIA-PhHOS","code_information":[{"code":"2810542","type":"CDM"},{"code":"361","type":"RC"},{"code":"27720","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.75,"setting":"both","billing_class":"facility"},{"gross_charge":1661.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FIBULA NONUNION-PhHOS","code_information":[{"code":"2810543","type":"CDM"},{"code":"361","type":"RC"},{"code":"27726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1843.25,"setting":"both","billing_class":"facility"},{"gross_charge":1843.25,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TIBIA FX-PhHOS","code_information":[{"code":"2810544","type":"CDM"},{"code":"361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"setting":"both","billing_class":"facility"},{"gross_charge":609.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TIBIA FX-PhHOS","code_information":[{"code":"2810545","type":"CDM"},{"code":"361","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.5,"setting":"both","billing_class":"facility"},{"gross_charge":943.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TIBIA FX-PhHOS","code_information":[{"code":"2810546","type":"CDM"},{"code":"361","type":"RC"},{"code":"27756","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.75,"setting":"both","billing_class":"facility"},{"gross_charge":1098.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TIBIA FX-PhHOS","code_information":[{"code":"2810547","type":"CDM"},{"code":"361","type":"RC"},{"code":"27759","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.5,"setting":"both","billing_class":"facility"},{"gross_charge":2057.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810548","type":"CDM"},{"code":"361","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"setting":"both","billing_class":"facility"},{"gross_charge":456.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810549","type":"CDM"},{"code":"361","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.5,"setting":"both","billing_class":"facility"},{"gross_charge":829.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810550","type":"CDM"},{"code":"361","type":"RC"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.75,"setting":"both","billing_class":"facility"},{"gross_charge":1158.75,"setting":"both","billing_class":"professional"}]},{"description":"CLTX POST ANKLE FX-PhHOS","code_information":[{"code":"2810551","type":"CDM"},{"code":"361","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.75,"setting":"both","billing_class":"facility"},{"gross_charge":496.75,"setting":"both","billing_class":"professional"}]},{"description":"OPTX POST ANKLE FX-PhHOS","code_information":[{"code":"2810552","type":"CDM"},{"code":"361","type":"RC"},{"code":"27769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.75,"setting":"both","billing_class":"facility"},{"gross_charge":1363.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF FIBULA FX-PhHOS","code_information":[{"code":"2810553","type":"CDM"},{"code":"361","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.75,"setting":"both","billing_class":"facility"},{"gross_charge":536.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF FIBULA FX-PhHOS","code_information":[{"code":"2810554","type":"CDM"},{"code":"361","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.5,"setting":"both","billing_class":"facility"},{"gross_charge":738.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF FIBULA FX-PhHOS","code_information":[{"code":"2810555","type":"CDM"},{"code":"361","type":"RC"},{"code":"27784","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.75,"setting":"both","billing_class":"facility"},{"gross_charge":1357.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810556","type":"CDM"},{"code":"361","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.5,"setting":"both","billing_class":"facility"},{"gross_charge":428.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810557","type":"CDM"},{"code":"361","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.5,"setting":"both","billing_class":"facility"},{"gross_charge":736.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810558","type":"CDM"},{"code":"361","type":"RC"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.75,"setting":"both","billing_class":"facility"},{"gross_charge":1355.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810559","type":"CDM"},{"code":"361","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.5,"setting":"both","billing_class":"facility"},{"gross_charge":578.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810560","type":"CDM"},{"code":"361","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"setting":"both","billing_class":"facility"},{"gross_charge":816.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810561","type":"CDM"},{"code":"361","type":"RC"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.75,"setting":"both","billing_class":"facility"},{"gross_charge":1464.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810562","type":"CDM"},{"code":"361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.5,"setting":"both","billing_class":"facility"},{"gross_charge":830.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810563","type":"CDM"},{"code":"361","type":"RC"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.5,"setting":"both","billing_class":"facility"},{"gross_charge":1599.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810564","type":"CDM"},{"code":"361","type":"RC"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.5,"setting":"both","billing_class":"facility"},{"gross_charge":1798.5,"setting":"both","billing_class":"professional"}]},{"description":"TX LOWER LEG FX-PhHOS","code_information":[{"code":"2810565","type":"CDM"},{"code":"361","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.5,"setting":"both","billing_class":"facility"},{"gross_charge":934.5,"setting":"both","billing_class":"professional"}]},{"description":"TX LOWER LEG FX-PhHOS","code_information":[{"code":"2810566","type":"CDM"},{"code":"361","type":"RC"},{"code":"27827","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.5,"setting":"both","billing_class":"facility"},{"gross_charge":2058.5,"setting":"both","billing_class":"professional"}]},{"description":"TX LOWER LEG FX-PhHOS","code_information":[{"code":"2810567","type":"CDM"},{"code":"361","type":"RC"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":2452.25,"setting":"both","billing_class":"facility"},{"gross_charge":2452.25,"setting":"both","billing_class":"professional"}]},{"description":"TX LOWER LEG JNT-PhHOS","code_information":[{"code":"2810568","type":"CDM"},{"code":"361","type":"RC"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.75,"setting":"both","billing_class":"facility"},{"gross_charge":1303.75,"setting":"both","billing_class":"professional"}]},{"description":"TX ANKLE DISLOC-PhHOS","code_information":[{"code":"2810569","type":"CDM"},{"code":"361","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"},{"gross_charge":941.5,"setting":"both","billing_class":"professional"}]},{"description":"FIXATION OF ANKLE JNT-PhHOS","code_information":[{"code":"2810570","type":"CDM"},{"code":"361","type":"RC"},{"code":"27860","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"setting":"both","billing_class":"facility"},{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE LOWER LEG-PhHOS","code_information":[{"code":"2810571","type":"CDM"},{"code":"361","type":"RC"},{"code":"27880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.5,"setting":"both","billing_class":"facility"},{"gross_charge":1756.5,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTE FOLLOW-UP SURG-PhHOS","code_information":[{"code":"2810572","type":"CDM"},{"code":"361","type":"RC"},{"code":"27886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.5,"setting":"both","billing_class":"facility"},{"gross_charge":1241.5,"setting":"both","billing_class":"professional"}]},{"description":"DECOMPRION OF LEG-PhHOS","code_information":[{"code":"2810573","type":"CDM"},{"code":"361","type":"RC"},{"code":"27892","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.75,"setting":"both","billing_class":"facility"},{"gross_charge":1047.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FOOT BONE LES-PhHOS","code_information":[{"code":"2810574","type":"CDM"},{"code":"361","type":"RC"},{"code":"28005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.5,"setting":"both","billing_class":"facility"},{"gross_charge":1095.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION FOOT FASCIA-PhHOS","code_information":[{"code":"2810575","type":"CDM"},{"code":"361","type":"RC"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"setting":"both","billing_class":"facility"},{"gross_charge":554.0,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORATION OF TOE JNT-PhHOS","code_information":[{"code":"2810576","type":"CDM"},{"code":"361","type":"RC"},{"code":"28024","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.5,"setting":"both","billing_class":"facility"},{"gross_charge":577.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FT/TOE TUM SC > 1.5CM-PhHOS","code_information":[{"code":"2810577","type":"CDM"},{"code":"361","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.25,"setting":"both","billing_class":"facility"},{"gross_charge":671.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF FOOT LES-PhHOS","code_information":[{"code":"2810578","type":"CDM"},{"code":"361","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.5,"setting":"both","billing_class":"facility"},{"gross_charge":482.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT LES-PhHOS","code_information":[{"code":"2810579","type":"CDM"},{"code":"361","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.5,"setting":"both","billing_class":"facility"},{"gross_charge":585.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TOE LESS-PhHOS","code_information":[{"code":"2810580","type":"CDM"},{"code":"361","type":"RC"},{"code":"28092","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.25,"setting":"both","billing_class":"facility"},{"gross_charge":516.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANKLE/HEEL LES-PhHOS","code_information":[{"code":"2810581","type":"CDM"},{"code":"361","type":"RC"},{"code":"28100","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.5,"setting":"both","billing_class":"facility"},{"gross_charge":779.5,"setting":"both","billing_class":"professional"}]},{"description":"PART REM OF METATARSAL-PhHOS","code_information":[{"code":"2810582","type":"CDM"},{"code":"361","type":"RC"},{"code":"28110","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.75,"setting":"both","billing_class":"facility"},{"gross_charge":539.75,"setting":"both","billing_class":"professional"}]},{"description":"PART REM OF ANKLE/HEEL-PhHOS","code_information":[{"code":"2810583","type":"CDM"},{"code":"361","type":"RC"},{"code":"28120","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.75,"setting":"both","billing_class":"facility"},{"gross_charge":949.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF FOOT BONE-PhHOS","code_information":[{"code":"2810584","type":"CDM"},{"code":"361","type":"RC"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"facility"},{"gross_charge":836.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF TOE-PhHOS","code_information":[{"code":"2810585","type":"CDM"},{"code":"361","type":"RC"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.5,"setting":"both","billing_class":"facility"},{"gross_charge":625.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT FB-PhHOS","code_information":[{"code":"2810586","type":"CDM"},{"code":"361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"facility"},{"gross_charge":255.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT FB-PhHOS","code_information":[{"code":"2810587","type":"CDM"},{"code":"361","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"setting":"both","billing_class":"facility"},{"gross_charge":600.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF FOOT TEND-PhHOS","code_information":[{"code":"2810588","type":"CDM"},{"code":"361","type":"RC"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.5,"setting":"both","billing_class":"facility"},{"gross_charge":585.5,"setting":"both","billing_class":"professional"}]},{"description":"REP OF HAMMERTOE-PhHOS","code_information":[{"code":"2810589","type":"CDM"},{"code":"361","type":"RC"},{"code":"28285","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.75,"setting":"both","billing_class":"facility"},{"gross_charge":748.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF FOOT BONE-PhHOS","code_information":[{"code":"2810590","type":"CDM"},{"code":"361","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.75,"setting":"both","billing_class":"facility"},{"gross_charge":791.75,"setting":"both","billing_class":"professional"}]},{"description":"REP HALLUX RIGIDUS-PhHOS","code_information":[{"code":"2810591","type":"CDM"},{"code":"361","type":"RC"},{"code":"28289","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.5,"setting":"both","billing_class":"facility"},{"gross_charge":1043.5,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION OF BUNION-PhHOS","code_information":[{"code":"2810593","type":"CDM"},{"code":"361","type":"RC"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.5,"setting":"both","billing_class":"facility"},{"gross_charge":983.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF HEEL FX-PhHOS","code_information":[{"code":"2810594","type":"CDM"},{"code":"361","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.75,"setting":"both","billing_class":"facility"},{"gross_charge":442.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF HEEL FX-PhHOS","code_information":[{"code":"2810595","type":"CDM"},{"code":"361","type":"RC"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"setting":"both","billing_class":"facility"},{"gross_charge":657.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2810596","type":"CDM"},{"code":"361","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"setting":"both","billing_class":"facility"},{"gross_charge":404.0,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSAL FX-PhHOS","code_information":[{"code":"2810597","type":"CDM"},{"code":"361","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.25,"setting":"both","billing_class":"facility"},{"gross_charge":309.25,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSAL FX-PhHOS","code_information":[{"code":"2810598","type":"CDM"},{"code":"361","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.5,"setting":"both","billing_class":"facility"},{"gross_charge":430.5,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSAL FX-PhHOS","code_information":[{"code":"2810599","type":"CDM"},{"code":"361","type":"RC"},{"code":"28476","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"setting":"both","billing_class":"facility"},{"gross_charge":651.0,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSAL FX-PhHOS","code_information":[{"code":"2810600","type":"CDM"},{"code":"361","type":"RC"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.75,"setting":"both","billing_class":"facility"},{"gross_charge":1000.75,"setting":"both","billing_class":"professional"}]},{"description":"TX BIG TOE FX-PhHOS","code_information":[{"code":"2810601","type":"CDM"},{"code":"361","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"setting":"both","billing_class":"facility"},{"gross_charge":244.0,"setting":"both","billing_class":"professional"}]},{"description":"TX BIG TOE FX-PhHOS","code_information":[{"code":"2810602","type":"CDM"},{"code":"361","type":"RC"},{"code":"28496","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"setting":"both","billing_class":"facility"},{"gross_charge":458.0,"setting":"both","billing_class":"professional"}]},{"description":"TX BIG TOE FX-PhHOS","code_information":[{"code":"2810603","type":"CDM"},{"code":"361","type":"RC"},{"code":"28505","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.75,"setting":"both","billing_class":"facility"},{"gross_charge":946.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TOE FX-PhHOS","code_information":[{"code":"2810604","type":"CDM"},{"code":"361","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF TOE FX-PhHOS","code_information":[{"code":"2810605","type":"CDM"},{"code":"361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"facility"},{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"TX TOE FX-PhHOS","code_information":[{"code":"2810606","type":"CDM"},{"code":"361","type":"RC"},{"code":"28525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1102.75,"setting":"both","billing_class":"facility"},{"gross_charge":1102.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FOOT DISLOC-PhHOS","code_information":[{"code":"2810607","type":"CDM"},{"code":"361","type":"RC"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"setting":"both","billing_class":"facility"},{"gross_charge":503.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FOOT DISLOC-PhHOS","code_information":[{"code":"2810608","type":"CDM"},{"code":"361","type":"RC"},{"code":"28605","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","billing_class":"facility"},{"gross_charge":565.25,"setting":"both","billing_class":"professional"}]},{"description":"TX FOOT DISLOC-PhHOS","code_information":[{"code":"2810609","type":"CDM"},{"code":"361","type":"RC"},{"code":"28606","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"setting":"both","billing_class":"facility"},{"gross_charge":756.0,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE TOE & METATAR-PhHOS","code_information":[{"code":"2810610","type":"CDM"},{"code":"361","type":"RC"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"facility"},{"gross_charge":836.5,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE TOE-PhHOS","code_information":[{"code":"2810611","type":"CDM"},{"code":"361","type":"RC"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.25,"setting":"both","billing_class":"facility"},{"gross_charge":766.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL AMPUTATE TOE-PhHOS","code_information":[{"code":"2810612","type":"CDM"},{"code":"361","type":"RC"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.25,"setting":"both","billing_class":"facility"},{"gross_charge":715.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG ARM CAST-PhHOS","code_information":[{"code":"2810613","type":"CDM"},{"code":"361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FOREARM CAST-PhHOS","code_information":[{"code":"2810614","type":"CDM"},{"code":"361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"setting":"both","billing_class":"facility"},{"gross_charge":93.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY HAND/WRIST CAST-PhHOS","code_information":[{"code":"2810615","type":"CDM"},{"code":"361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"setting":"both","billing_class":"facility"},{"gross_charge":100.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG ARM SPLINT-PhHOS","code_information":[{"code":"2810616","type":"CDM"},{"code":"361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"facility"},{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FOREARM SPLINT-PhHOS","code_information":[{"code":"2810617","type":"CDM"},{"code":"361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FINGER SPLINT-PhHOS","code_information":[{"code":"2810618","type":"CDM"},{"code":"361","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"facility"},{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FINGER SPLINT-PhHOS","code_information":[{"code":"2810619","type":"CDM"},{"code":"361","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING OF SHOULDER-PhHOS","code_information":[{"code":"2810620","type":"CDM"},{"code":"361","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG CAST-PhHOS","code_information":[{"code":"2810621","type":"CDM"},{"code":"361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"facility"},{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG CAST-PhHOS","code_information":[{"code":"2810622","type":"CDM"},{"code":"361","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG CAST-PhHOS","code_information":[{"code":"2810623","type":"CDM"},{"code":"361","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.5,"setting":"both","billing_class":"facility"},{"gross_charge":167.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PhHOS","code_information":[{"code":"2810624","type":"CDM"},{"code":"361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"facility"},{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PhHOS","code_information":[{"code":"2810625","type":"CDM"},{"code":"361","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PhHOS","code_information":[{"code":"2810626","type":"CDM"},{"code":"361","type":"RC"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.25,"setting":"both","billing_class":"facility"},{"gross_charge":161.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LEG CAST-PhHOS","code_information":[{"code":"2810627","type":"CDM"},{"code":"361","type":"RC"},{"code":"29450","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG SPLINT-PhHOS","code_information":[{"code":"2810628","type":"CDM"},{"code":"361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LOWER LEG SPLINT-PhHOS","code_information":[{"code":"2810629","type":"CDM"},{"code":"361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING ANK AND/OR FT-PhHOS","code_information":[{"code":"2810630","type":"CDM"},{"code":"361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY PASTE BOOT-PhHOS","code_information":[{"code":"2810631","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVION OF CAST-PhHOS","code_information":[{"code":"2810632","type":"CDM"},{"code":"361","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVION OF CAST-PhHOS","code_information":[{"code":"2810633","type":"CDM"},{"code":"361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"WINDOWING OF CAST-PhHOS","code_information":[{"code":"2810634","type":"CDM"},{"code":"361","type":"RC"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.75,"setting":"both","billing_class":"professional"}]},{"description":"WEDGING OF CAST-PhHOS","code_information":[{"code":"2810635","type":"CDM"},{"code":"361","type":"RC"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"},{"gross_charge":123.5,"setting":"both","billing_class":"professional"}]},{"description":"CASTING/STRAPPING-PhHOS","code_information":[{"code":"2810636","type":"CDM"},{"code":"361","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO DX-PhHOS","code_information":[{"code":"2810637","type":"CDM"},{"code":"361","type":"RC"},{"code":"29805","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.75,"setting":"both","billing_class":"facility"},{"gross_charge":896.75,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810638","type":"CDM"},{"code":"361","type":"RC"},{"code":"29806","type":"HCPCS"}],"standard_charges":[{"gross_charge":2007.5,"setting":"both","billing_class":"facility"},{"gross_charge":2007.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810639","type":"CDM"},{"code":"361","type":"RC"},{"code":"29807","type":"HCPCS"}],"standard_charges":[{"gross_charge":1957.5,"setting":"both","billing_class":"facility"},{"gross_charge":1957.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810640","type":"CDM"},{"code":"361","type":"RC"},{"code":"29819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"setting":"both","billing_class":"facility"},{"gross_charge":1112.0,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810641","type":"CDM"},{"code":"361","type":"RC"},{"code":"29820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.25,"setting":"both","billing_class":"facility"},{"gross_charge":1025.25,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810642","type":"CDM"},{"code":"361","type":"RC"},{"code":"29822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.5,"setting":"both","billing_class":"facility"},{"gross_charge":1191.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810643","type":"CDM"},{"code":"361","type":"RC"},{"code":"29823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.5,"setting":"both","billing_class":"facility"},{"gross_charge":1299.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810644","type":"CDM"},{"code":"361","type":"RC"},{"code":"29824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.75,"setting":"both","billing_class":"facility"},{"gross_charge":1403.75,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810645","type":"CDM"},{"code":"361","type":"RC"},{"code":"29825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"setting":"both","billing_class":"facility"},{"gross_charge":1112.0,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHRO/SURG-PhHOS","code_information":[{"code":"2810646","type":"CDM"},{"code":"361","type":"RC"},{"code":"29826","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"facility"},{"gross_charge":360.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRO ROTATOR CUFF REPR-PhHOS","code_information":[{"code":"2810647","type":"CDM"},{"code":"361","type":"RC"},{"code":"29827","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.0,"setting":"both","billing_class":"facility"},{"gross_charge":2032.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRO BICEPS TENODESIS-PhHOS","code_information":[{"code":"2810648","type":"CDM"},{"code":"361","type":"RC"},{"code":"29828","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.5,"setting":"both","billing_class":"facility"},{"gross_charge":1749.5,"setting":"both","billing_class":"professional"}]},{"description":"ELBOW ARTHRO/SURG-PhHOS","code_information":[{"code":"2810649","type":"CDM"},{"code":"361","type":"RC"},{"code":"29837","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.5,"setting":"both","billing_class":"facility"},{"gross_charge":982.5,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810650","type":"CDM"},{"code":"361","type":"RC"},{"code":"29851","type":"HCPCS"}],"standard_charges":[{"gross_charge":1630.0,"setting":"both","billing_class":"facility"},{"gross_charge":1630.0,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHRO/SURG-PhHOS","code_information":[{"code":"2810651","type":"CDM"},{"code":"361","type":"RC"},{"code":"29862","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.25,"setting":"both","billing_class":"facility"},{"gross_charge":1483.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO DX-PhHOS","code_information":[{"code":"2810652","type":"CDM"},{"code":"361","type":"RC"},{"code":"29870","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.5,"setting":"both","billing_class":"facility"},{"gross_charge":784.5,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/DRAINAGE-PhHOS","code_information":[{"code":"2810653","type":"CDM"},{"code":"361","type":"RC"},{"code":"29871","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.25,"setting":"both","billing_class":"facility"},{"gross_charge":976.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810654","type":"CDM"},{"code":"361","type":"RC"},{"code":"29874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"setting":"both","billing_class":"facility"},{"gross_charge":1114.0,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810655","type":"CDM"},{"code":"361","type":"RC"},{"code":"29875","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.25,"setting":"both","billing_class":"facility"},{"gross_charge":1027.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810656","type":"CDM"},{"code":"361","type":"RC"},{"code":"29876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.75,"setting":"both","billing_class":"facility"},{"gross_charge":1357.75,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810657","type":"CDM"},{"code":"361","type":"RC"},{"code":"29877","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.5,"setting":"both","billing_class":"facility"},{"gross_charge":1290.5,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810658","type":"CDM"},{"code":"361","type":"RC"},{"code":"29879","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"setting":"both","billing_class":"facility"},{"gross_charge":1373.0,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810659","type":"CDM"},{"code":"361","type":"RC"},{"code":"29880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"setting":"both","billing_class":"facility"},{"gross_charge":1168.0,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810660","type":"CDM"},{"code":"361","type":"RC"},{"code":"29881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.25,"setting":"both","billing_class":"facility"},{"gross_charge":1125.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810661","type":"CDM"},{"code":"361","type":"RC"},{"code":"29882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.75,"setting":"both","billing_class":"facility"},{"gross_charge":1360.75,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810662","type":"CDM"},{"code":"361","type":"RC"},{"code":"29884","type":"HCPCS"}],"standard_charges":[{"gross_charge":1180.25,"setting":"both","billing_class":"facility"},{"gross_charge":1180.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810663","type":"CDM"},{"code":"361","type":"RC"},{"code":"29888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2040.0,"setting":"both","billing_class":"facility"},{"gross_charge":2040.0,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810664","type":"CDM"},{"code":"361","type":"RC"},{"code":"29889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.5,"setting":"both","billing_class":"facility"},{"gross_charge":2308.5,"setting":"both","billing_class":"professional"}]},{"description":"ANKLE ARTHRO/SURG-PhHOS","code_information":[{"code":"2810665","type":"CDM"},{"code":"361","type":"RC"},{"code":"29895","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHR W/FEMOROPLASTY-PhHOS","code_information":[{"code":"2810666","type":"CDM"},{"code":"361","type":"RC"},{"code":"29914","type":"HCPCS"}],"standard_charges":[{"gross_charge":1829.0,"setting":"both","billing_class":"facility"},{"gross_charge":1829.0,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHRO W/LABRAL REP-PhHOS","code_information":[{"code":"2810667","type":"CDM"},{"code":"361","type":"RC"},{"code":"29916","type":"HCPCS"}],"standard_charges":[{"gross_charge":1864.75,"setting":"both","billing_class":"facility"},{"gross_charge":1864.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN NOSE LES-PhHOS","code_information":[{"code":"2810668","type":"CDM"},{"code":"361","type":"RC"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN NOSE LES-PhHOS","code_information":[{"code":"2810669","type":"CDM"},{"code":"361","type":"RC"},{"code":"30020","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.5,"setting":"both","billing_class":"facility"},{"gross_charge":228.5,"setting":"both","billing_class":"professional"}]},{"description":"INTRANASAL BX-PhHOS","code_information":[{"code":"2810670","type":"CDM"},{"code":"361","type":"RC"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.75,"setting":"both","billing_class":"facility"},{"gross_charge":130.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NOSE POLYP-PhHOS","code_information":[{"code":"2810671","type":"CDM"},{"code":"361","type":"RC"},{"code":"30115","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.5,"setting":"both","billing_class":"facility"},{"gross_charge":832.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF INTRANASAL LES-PhHOS","code_information":[{"code":"2810672","type":"CDM"},{"code":"361","type":"RC"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"setting":"both","billing_class":"facility"},{"gross_charge":655.0,"setting":"both","billing_class":"professional"}]},{"description":"RESECT INFER TURBINATE-PhHOS","code_information":[{"code":"2810673","type":"CDM"},{"code":"361","type":"RC"},{"code":"30140","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"setting":"both","billing_class":"facility"},{"gross_charge":860.0,"setting":"both","billing_class":"professional"}]},{"description":"REM NASAL FB-PhHOS","code_information":[{"code":"2810674","type":"CDM"},{"code":"361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility"},{"gross_charge":249.0,"setting":"both","billing_class":"professional"}]},{"description":"REM NASAL FB-PhHOS","code_information":[{"code":"2810675","type":"CDM"},{"code":"361","type":"RC"},{"code":"30310","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"setting":"both","billing_class":"facility"},{"gross_charge":401.0,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTRION OF NOSE-PhHOS","code_information":[{"code":"2810676","type":"CDM"},{"code":"361","type":"RC"},{"code":"30420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2555.25,"setting":"both","billing_class":"facility"},{"gross_charge":2555.25,"setting":"both","billing_class":"professional"}]},{"description":"REP NASAL STENOSIS-PhHOS","code_information":[{"code":"2810677","type":"CDM"},{"code":"361","type":"RC"},{"code":"30465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"setting":"both","billing_class":"facility"},{"gross_charge":1881.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF NASAL SEPTUM-PhHOS","code_information":[{"code":"2810678","type":"CDM"},{"code":"361","type":"RC"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1203.75,"setting":"both","billing_class":"facility"},{"gross_charge":1203.75,"setting":"both","billing_class":"professional"}]},{"description":"REL OF NASAL ADHESIONS-PhHOS","code_information":[{"code":"2810679","type":"CDM"},{"code":"361","type":"RC"},{"code":"30560","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.25,"setting":"both","billing_class":"facility"},{"gross_charge":256.25,"setting":"both","billing_class":"professional"}]},{"description":"ABLATE INF TURB SUPERF-PhHOS","code_information":[{"code":"2810680","type":"CDM"},{"code":"361","type":"RC"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.5,"setting":"both","billing_class":"facility"},{"gross_charge":269.5,"setting":"both","billing_class":"professional"}]},{"description":"CAUTERIZATION INNER NOSE-PhHOS","code_information":[{"code":"2810681","type":"CDM"},{"code":"361","type":"RC"},{"code":"30802","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.25,"setting":"both","billing_class":"facility"},{"gross_charge":368.25,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSEBLEED-PhHOS","code_information":[{"code":"2810682","type":"CDM"},{"code":"361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSEBLEED-PhHOS","code_information":[{"code":"2810683","type":"CDM"},{"code":"361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"facility"},{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSEBLEED-PhHOS","code_information":[{"code":"2810684","type":"CDM"},{"code":"361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"facility"},{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"THER FX NASAL INF TURB-PhHOS","code_information":[{"code":"2810685","type":"CDM"},{"code":"361","type":"RC"},{"code":"30930","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"facility"},{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ETHMOID SINUS-PhHOS","code_information":[{"code":"2810686","type":"CDM"},{"code":"361","type":"RC"},{"code":"31200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.75,"setting":"both","billing_class":"facility"},{"gross_charge":1107.75,"setting":"both","billing_class":"professional"}]},{"description":"NASAL ENDO DX-PhHOS","code_information":[{"code":"2810687","type":"CDM"},{"code":"361","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC BX POLYPC-PhHOS","code_information":[{"code":"2810688","type":"CDM"},{"code":"361","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF ETHMOID SINUS-PhHOS","code_information":[{"code":"2810690","type":"CDM"},{"code":"361","type":"RC"},{"code":"31254","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.25,"setting":"both","billing_class":"facility"},{"gross_charge":515.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ETHMOID SINUS-PhHOS","code_information":[{"code":"2810691","type":"CDM"},{"code":"361","type":"RC"},{"code":"31255","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.75,"setting":"both","billing_class":"facility"},{"gross_charge":750.75,"setting":"both","billing_class":"professional"}]},{"description":"ENDO MAXILLARY SINUS-PhHOS","code_information":[{"code":"2810692","type":"CDM"},{"code":"361","type":"RC"},{"code":"31267","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.75,"setting":"both","billing_class":"facility"},{"gross_charge":596.75,"setting":"both","billing_class":"professional"}]},{"description":"SINUS ENDO SURGICAL-PhHOS","code_information":[{"code":"2810693","type":"CDM"},{"code":"361","type":"RC"},{"code":"31276","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.75,"setting":"both","billing_class":"facility"},{"gross_charge":949.75,"setting":"both","billing_class":"professional"}]},{"description":"SINUS ENDO W/BALLOON DIL-PhHOS","code_information":[{"code":"2810695","type":"CDM"},{"code":"361","type":"RC"},{"code":"31295","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"facility"},{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"SINUS ENDO W/BALLOON DIL-PhHOS","code_information":[{"code":"2810696","type":"CDM"},{"code":"361","type":"RC"},{"code":"31296","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"facility"},{"gross_charge":337.75,"setting":"both","billing_class":"professional"}]},{"description":"SINUS ENDO W/BALLOON DIL-PhHOS","code_information":[{"code":"2810697","type":"CDM"},{"code":"361","type":"RC"},{"code":"31297","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.5,"setting":"both","billing_class":"facility"},{"gross_charge":268.5,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC W/SINS DIL-PhHOS","code_information":[{"code":"2810698","type":"CDM"},{"code":"361","type":"RC"},{"code":"31298","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.25,"setting":"both","billing_class":"facility"},{"gross_charge":469.25,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE WINDPIPE AIRWAY-PhHOS","code_information":[{"code":"2810699","type":"CDM"},{"code":"361","type":"RC"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC LARYNGSC-PhHOS","code_information":[{"code":"2810700","type":"CDM"},{"code":"361","type":"RC"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"REM FB LARYNX-PhHOS","code_information":[{"code":"2810701","type":"CDM"},{"code":"361","type":"RC"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"facility"},{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"DX LARYNGSC EXL NB-PhHOS","code_information":[{"code":"2810702","type":"CDM"},{"code":"361","type":"RC"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"facility"},{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGSC W/FB REM-PhHOS","code_information":[{"code":"2810703","type":"CDM"},{"code":"361","type":"RC"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.5,"setting":"both","billing_class":"facility"},{"gross_charge":374.5,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGSC W/BX-PhHOS","code_information":[{"code":"2810704","type":"CDM"},{"code":"361","type":"RC"},{"code":"31535","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"facility"},{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGSC W/BX & OP SCOPE-PhHOS","code_information":[{"code":"2810705","type":"CDM"},{"code":"361","type":"RC"},{"code":"31536","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"setting":"both","billing_class":"facility"},{"gross_charge":401.0,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGSC W/TUMR EX & SC-PhHOS","code_information":[{"code":"2810706","type":"CDM"},{"code":"361","type":"RC"},{"code":"31541","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"setting":"both","billing_class":"facility"},{"gross_charge":503.0,"setting":"both","billing_class":"professional"}]},{"description":"REM VC LES W/SCOPE-PhHOS","code_information":[{"code":"2810707","type":"CDM"},{"code":"361","type":"RC"},{"code":"31545","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.5,"setting":"both","billing_class":"facility"},{"gross_charge":688.5,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC LARYNGSC-PhHOS","code_information":[{"code":"2810708","type":"CDM"},{"code":"361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF LARYNX LES-PhHOS","code_information":[{"code":"2810709","type":"CDM"},{"code":"361","type":"RC"},{"code":"31578","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.5,"setting":"both","billing_class":"facility"},{"gross_charge":326.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION WINDPIPE-PhHOS","code_information":[{"code":"2810710","type":"CDM"},{"code":"361","type":"RC"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.75,"setting":"both","billing_class":"facility"},{"gross_charge":747.75,"setting":"both","billing_class":"professional"}]},{"description":"REP WINDPIPE OPENING-PhHOS","code_information":[{"code":"2810711","type":"CDM"},{"code":"361","type":"RC"},{"code":"31613","type":"HCPCS"}],"standard_charges":[{"gross_charge":882.5,"setting":"both","billing_class":"facility"},{"gross_charge":882.5,"setting":"both","billing_class":"professional"}]},{"description":"DX BRONCHOSCOPE/WASH-PhHOS","code_information":[{"code":"2810712","type":"CDM"},{"code":"361","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"facility"},{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"DX BRONCHOSCOPE/BRUSH-PhHOS","code_information":[{"code":"2810713","type":"CDM"},{"code":"361","type":"RC"},{"code":"31623","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"facility"},{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"DX BRONCHOSCOPE/LAVAGE-PhHOS","code_information":[{"code":"2810714","type":"CDM"},{"code":"361","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.5,"setting":"both","billing_class":"facility"},{"gross_charge":279.5,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH W/BX-PhHOS","code_information":[{"code":"2810715","type":"CDM"},{"code":"361","type":"RC"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.5,"setting":"both","billing_class":"facility"},{"gross_charge":322.5,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH/LUNG BX EACH-PhHOS","code_information":[{"code":"2810716","type":"CDM"},{"code":"361","type":"RC"},{"code":"31628","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.75,"setting":"both","billing_class":"facility"},{"gross_charge":391.75,"setting":"both","billing_class":"professional"}]},{"description":"BRONCHOSC/NEEDLE BX EACH-PhHOS","code_information":[{"code":"2810717","type":"CDM"},{"code":"361","type":"RC"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.75,"setting":"both","billing_class":"facility"},{"gross_charge":386.75,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH/LUNG BX ADD'L-PhHOS","code_information":[{"code":"2810718","type":"CDM"},{"code":"361","type":"RC"},{"code":"31632","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"facility"},{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH CLEAR AIRWAYS-PhHOS","code_information":[{"code":"2810719","type":"CDM"},{"code":"361","type":"RC"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"setting":"both","billing_class":"facility"},{"gross_charge":306.0,"setting":"both","billing_class":"professional"}]},{"description":"BRONCHOSC RECLEAR AIRWAY-PhHOS","code_information":[{"code":"2810720","type":"CDM"},{"code":"361","type":"RC"},{"code":"31646","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEST TUBE INSERTION-PhHOS","code_information":[{"code":"2810721","type":"CDM"},{"code":"361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.75,"setting":"both","billing_class":"facility"},{"gross_charge":332.75,"setting":"both","billing_class":"professional"}]},{"description":"ASP PLEURA W/O IMAGE-PhHOS","code_information":[{"code":"2810722","type":"CDM"},{"code":"361","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.5,"setting":"both","billing_class":"facility"},{"gross_charge":168.5,"setting":"both","billing_class":"professional"}]},{"description":"ASP PLEURA W/ IMAGING-PhHOS","code_information":[{"code":"2810723","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.25,"setting":"both","billing_class":"facility"},{"gross_charge":210.25,"setting":"both","billing_class":"professional"}]},{"description":"TX PLEURODESIS W/AGENT-PhHOS","code_information":[{"code":"2810724","type":"CDM"},{"code":"361","type":"RC"},{"code":"32560","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"facility"},{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HEART PACEMAKER-PhHOS","code_information":[{"code":"2810725","type":"CDM"},{"code":"361","type":"RC"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"setting":"both","billing_class":"facility"},{"gross_charge":910.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HEART PACEMAKER-PhHOS","code_information":[{"code":"2810726","type":"CDM"},{"code":"361","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.5,"setting":"both","billing_class":"facility"},{"gross_charge":983.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HEART ELECTRODE-PhHOS","code_information":[{"code":"2810727","type":"CDM"},{"code":"361","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.75,"setting":"both","billing_class":"facility"},{"gross_charge":332.75,"setting":"both","billing_class":"professional"}]},{"description":"INS LEAD PACE-DEFIB ONE-PhHOS","code_information":[{"code":"2810728","type":"CDM"},{"code":"361","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"setting":"both","billing_class":"facility"},{"gross_charge":706.0,"setting":"both","billing_class":"professional"}]},{"description":"REPOSIT L VENTRIC LEAD-PhHOS","code_information":[{"code":"2810729","type":"CDM"},{"code":"361","type":"RC"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"setting":"both","billing_class":"facility"},{"gross_charge":913.0,"setting":"both","billing_class":"professional"}]},{"description":"REM&REPLACE PM GEN SINGL-PhHOS","code_information":[{"code":"2810730","type":"CDM"},{"code":"361","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"setting":"both","billing_class":"facility"},{"gross_charge":652.0,"setting":"both","billing_class":"professional"}]},{"description":"REM/REPLC PM DUAL LEAD-PhHOS","code_information":[{"code":"2810731","type":"CDM"},{"code":"361","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.5,"setting":"both","billing_class":"facility"},{"gross_charge":679.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF PACEMAKER SYSTEM-PhHOS","code_information":[{"code":"2810732","type":"CDM"},{"code":"361","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"setting":"both","billing_class":"facility"},{"gross_charge":447.0,"setting":"both","billing_class":"professional"}]},{"description":"REM PACEMAKER ELECTRODE-PhHOS","code_information":[{"code":"2810733","type":"CDM"},{"code":"361","type":"RC"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.5,"setting":"both","billing_class":"facility"},{"gross_charge":1195.5,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE ABD VESSELS-PhHOS","code_information":[{"code":"2810734","type":"CDM"},{"code":"361","type":"RC"},{"code":"35840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2266.5,"setting":"both","billing_class":"facility"},{"gross_charge":2266.5,"setting":"both","billing_class":"professional"}]},{"description":"NONROUTINE BL DRAW> 3YR-PhHOS","code_information":[{"code":"2810735","type":"CDM"},{"code":"361","type":"RC"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"facility"},{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ THERAPY OF VEINS-PhHOS","code_information":[{"code":"2810736","type":"CDM"},{"code":"361","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"setting":"both","billing_class":"facility"},{"gross_charge":151.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDOVENOUS RF 1ST VEIN-PhHOS","code_information":[{"code":"2810737","type":"CDM"},{"code":"361","type":"RC"},{"code":"36475","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.25,"setting":"both","billing_class":"facility"},{"gross_charge":675.25,"setting":"both","billing_class":"professional"}]},{"description":"CENTRAL LINE INSERT-PhHOS","code_information":[{"code":"2810738","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"facility"},{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810739","type":"CDM"},{"code":"361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.5,"setting":"both","billing_class":"facility"},{"gross_charge":529.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810740","type":"CDM"},{"code":"361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.5,"setting":"both","billing_class":"facility"},{"gross_charge":678.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT PICVAD CATH-PhHOS","code_information":[{"code":"2810741","type":"CDM"},{"code":"361","type":"RC"},{"code":"36571","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.25,"setting":"both","billing_class":"facility"},{"gross_charge":616.25,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810742","type":"CDM"},{"code":"361","type":"RC"},{"code":"36578","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.5,"setting":"both","billing_class":"facility"},{"gross_charge":376.5,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810743","type":"CDM"},{"code":"361","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.5,"setting":"both","billing_class":"facility"},{"gross_charge":372.5,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810744","type":"CDM"},{"code":"361","type":"RC"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","billing_class":"facility"},{"gross_charge":582.5,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810745","type":"CDM"},{"code":"361","type":"RC"},{"code":"36583","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.5,"setting":"both","billing_class":"facility"},{"gross_charge":630.5,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810746","type":"CDM"},{"code":"361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-PhHOS","code_information":[{"code":"2810747","type":"CDM"},{"code":"361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.75,"setting":"both","billing_class":"facility"},{"gross_charge":392.75,"setting":"both","billing_class":"professional"}]},{"description":"REPOS VENOUS CATHETER-PhHOS","code_information":[{"code":"2810748","type":"CDM"},{"code":"361","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"facility"},{"gross_charge":115.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ W/FLUOR EVAL CV DEV-PhHOS","code_information":[{"code":"2810749","type":"CDM"},{"code":"361","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT CATHETER ARTERY-PhHOS","code_information":[{"code":"2810750","type":"CDM"},{"code":"361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT CATHETER ARTERY-PhHOS","code_information":[{"code":"2810751","type":"CDM"},{"code":"361","type":"RC"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"},{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"INS ENDOV VENA CAVA FILT-PhHOS","code_information":[{"code":"2810752","type":"CDM"},{"code":"361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"setting":"both","billing_class":"facility"},{"gross_charge":451.0,"setting":"both","billing_class":"professional"}]},{"description":"TEMPORAL ARTERY PROC-PhHOS","code_information":[{"code":"2810753","type":"CDM"},{"code":"361","type":"RC"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"setting":"both","billing_class":"facility"},{"gross_charge":404.0,"setting":"both","billing_class":"professional"}]},{"description":"REV LEG VEIN-PhHOS","code_information":[{"code":"2810754","type":"CDM"},{"code":"361","type":"RC"},{"code":"37700","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.75,"setting":"both","billing_class":"facility"},{"gross_charge":490.75,"setting":"both","billing_class":"professional"}]},{"description":"LIGATE/STR LONG LEG VEIN-PhHOS","code_information":[{"code":"2810755","type":"CDM"},{"code":"361","type":"RC"},{"code":"37722","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.0,"setting":"both","billing_class":"facility"},{"gross_charge":917.0,"setting":"both","billing_class":"professional"}]},{"description":"PHLEB VEINS EXREM TO 20-PhHOS","code_information":[{"code":"2810756","type":"CDM"},{"code":"361","type":"RC"},{"code":"37765","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.25,"setting":"both","billing_class":"facility"},{"gross_charge":872.25,"setting":"both","billing_class":"professional"}]},{"description":"LIGATE/DIVIDE/EXISE VEIN-PhHOS","code_information":[{"code":"2810757","type":"CDM"},{"code":"361","type":"RC"},{"code":"37785","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.25,"setting":"both","billing_class":"facility"},{"gross_charge":512.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPLEEN TOTAL-PhHOS","code_information":[{"code":"2810758","type":"CDM"},{"code":"361","type":"RC"},{"code":"38100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPLEEN TOTAL-PhHOS","code_information":[{"code":"2810759","type":"CDM"},{"code":"361","type":"RC"},{"code":"38102","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.75,"setting":"both","billing_class":"facility"},{"gross_charge":487.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE MARROW BX-PhHOS","code_information":[{"code":"2810760","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.75,"setting":"both","billing_class":"facility"},{"gross_charge":138.75,"setting":"both","billing_class":"professional"}]},{"description":"BX/REM LYMPH NODES-PhHOS","code_information":[{"code":"2810761","type":"CDM"},{"code":"361","type":"RC"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.75,"setting":"both","billing_class":"facility"},{"gross_charge":485.75,"setting":"both","billing_class":"professional"}]},{"description":"BX/REM LYMPH NODES-PhHOS","code_information":[{"code":"2810762","type":"CDM"},{"code":"361","type":"RC"},{"code":"38510","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.75,"setting":"both","billing_class":"facility"},{"gross_charge":795.75,"setting":"both","billing_class":"professional"}]},{"description":"BX/REM LYMPH NODES-PhHOS","code_information":[{"code":"2810763","type":"CDM"},{"code":"361","type":"RC"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.25,"setting":"both","billing_class":"facility"},{"gross_charge":827.25,"setting":"both","billing_class":"professional"}]},{"description":"BX/REM LYMPH NODES-PhHOS","code_information":[{"code":"2810764","type":"CDM"},{"code":"361","type":"RC"},{"code":"38530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.25,"setting":"both","billing_class":"facility"},{"gross_charge":1029.25,"setting":"both","billing_class":"professional"}]},{"description":"REM ABDOMEN LYMPH NODES-PhHOS","code_information":[{"code":"2810765","type":"CDM"},{"code":"361","type":"RC"},{"code":"38564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"setting":"both","billing_class":"facility"},{"gross_charge":1317.0,"setting":"both","billing_class":"professional"}]},{"description":"REM ARMPIT LYMPH NODES-PhHOS","code_information":[{"code":"2810766","type":"CDM"},{"code":"361","type":"RC"},{"code":"38745","type":"HCPCS"}],"standard_charges":[{"gross_charge":1707.5,"setting":"both","billing_class":"facility"},{"gross_charge":1707.5,"setting":"both","billing_class":"professional"}]},{"description":"REM PELVIS LYMPH NODES-PhHOS","code_information":[{"code":"2810767","type":"CDM"},{"code":"361","type":"RC"},{"code":"38770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.25,"setting":"both","billing_class":"facility"},{"gross_charge":1490.25,"setting":"both","billing_class":"professional"}]},{"description":"IO MAP SENT LYMPH NODE-PhHOS","code_information":[{"code":"2810768","type":"CDM"},{"code":"361","type":"RC"},{"code":"38900","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.25,"setting":"both","billing_class":"facility"},{"gross_charge":257.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF DIAPHRAGM HERN-PhHOS","code_information":[{"code":"2810769","type":"CDM"},{"code":"361","type":"RC"},{"code":"39541","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"setting":"both","billing_class":"facility"},{"gross_charge":1776.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF LIP-PhHOS","code_information":[{"code":"2810770","type":"CDM"},{"code":"361","type":"RC"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FB MOUTH-PhHOS","code_information":[{"code":"2810771","type":"CDM"},{"code":"361","type":"RC"},{"code":"40805","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.25,"setting":"both","billing_class":"facility"},{"gross_charge":466.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISION LIP FOLD-PhHOS","code_information":[{"code":"2810772","type":"CDM"},{"code":"361","type":"RC"},{"code":"40806","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF MOUTH LES-PhHOS","code_information":[{"code":"2810773","type":"CDM"},{"code":"361","type":"RC"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":251.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISE/REP MOUTH LES-PhHOS","code_information":[{"code":"2810774","type":"CDM"},{"code":"361","type":"RC"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.75,"setting":"both","billing_class":"facility"},{"gross_charge":287.75,"setting":"both","billing_class":"professional"}]},{"description":"EXISE LIP OR CHEEK FOLD-PhHOS","code_information":[{"code":"2810775","type":"CDM"},{"code":"361","type":"RC"},{"code":"40819","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.25,"setting":"both","billing_class":"facility"},{"gross_charge":460.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISION TONGUE FOLD-PhHOS","code_information":[{"code":"2810776","type":"CDM"},{"code":"361","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.25,"setting":"both","billing_class":"facility"},{"gross_charge":215.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF TONGUE-PhHOS","code_information":[{"code":"2810777","type":"CDM"},{"code":"361","type":"RC"},{"code":"41105","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.25,"setting":"both","billing_class":"facility"},{"gross_charge":216.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF TONGUE LES-PhHOS","code_information":[{"code":"2810778","type":"CDM"},{"code":"361","type":"RC"},{"code":"41110","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.25,"setting":"both","billing_class":"facility"},{"gross_charge":259.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF TONGUE LES-PhHOS","code_information":[{"code":"2810779","type":"CDM"},{"code":"361","type":"RC"},{"code":"41112","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.5,"setting":"both","billing_class":"facility"},{"gross_charge":483.5,"setting":"both","billing_class":"professional"}]},{"description":"EX OF TONGUE FOLD-PhHOS","code_information":[{"code":"2810780","type":"CDM"},{"code":"361","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"facility"},{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE MOUTH ROOF LES-PhHOS","code_information":[{"code":"2810781","type":"CDM"},{"code":"361","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"EX LES MOUTH ROOF-PhHOS","code_information":[{"code":"2810782","type":"CDM"},{"code":"361","type":"RC"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"REM PALATE/LES-PhHOS","code_information":[{"code":"2810783","type":"CDM"},{"code":"361","type":"RC"},{"code":"42120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1932.0,"setting":"both","billing_class":"facility"},{"gross_charge":1932.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF UVULA-PhHOS","code_information":[{"code":"2810784","type":"CDM"},{"code":"361","type":"RC"},{"code":"42140","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"REP PALATE PHARYNX/UVULA-PhHOS","code_information":[{"code":"2810785","type":"CDM"},{"code":"361","type":"RC"},{"code":"42145","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.75,"setting":"both","billing_class":"facility"},{"gross_charge":1363.75,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTR CLEFT PALATE-PhHOS","code_information":[{"code":"2810786","type":"CDM"},{"code":"361","type":"RC"},{"code":"42200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.5,"setting":"both","billing_class":"facility"},{"gross_charge":1799.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF SALIVARY GLAND-PhHOS","code_information":[{"code":"2810787","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISE PAROTID GLAND/LES-PhHOS","code_information":[{"code":"2810788","type":"CDM"},{"code":"361","type":"RC"},{"code":"42415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.25,"setting":"both","billing_class":"facility"},{"gross_charge":1996.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISE PAROTID GLAND/LES-PhHOS","code_information":[{"code":"2810789","type":"CDM"},{"code":"361","type":"RC"},{"code":"42420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2261.5,"setting":"both","billing_class":"facility"},{"gross_charge":2261.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN TONSIL ABSCESS-PhHOS","code_information":[{"code":"2810790","type":"CDM"},{"code":"361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN THROAT ABSCESS-PhHOS","code_information":[{"code":"2810791","type":"CDM"},{"code":"361","type":"RC"},{"code":"42720","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.75,"setting":"both","billing_class":"facility"},{"gross_charge":750.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF THROAT-PhHOS","code_information":[{"code":"2810792","type":"CDM"},{"code":"361","type":"RC"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","billing_class":"facility"},{"gross_charge":218.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISE PHARYNX LES-PhHOS","code_information":[{"code":"2810793","type":"CDM"},{"code":"361","type":"RC"},{"code":"42808","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"REM PHARYNX FB-PhHOS","code_information":[{"code":"2810794","type":"CDM"},{"code":"361","type":"RC"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.5,"setting":"both","billing_class":"facility"},{"gross_charge":225.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF NECK CYST-PhHOS","code_information":[{"code":"2810795","type":"CDM"},{"code":"361","type":"RC"},{"code":"42815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"REM TONSILS AND ADENOIDS-PhHOS","code_information":[{"code":"2810796","type":"CDM"},{"code":"361","type":"RC"},{"code":"42820","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"setting":"both","billing_class":"facility"},{"gross_charge":559.0,"setting":"both","billing_class":"professional"}]},{"description":"REM TONSILS AND ADENOIDS-PhHOS","code_information":[{"code":"2810797","type":"CDM"},{"code":"361","type":"RC"},{"code":"42821","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.5,"setting":"both","billing_class":"facility"},{"gross_charge":581.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TONSILS-PhHOS","code_information":[{"code":"2810798","type":"CDM"},{"code":"361","type":"RC"},{"code":"42825","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"setting":"both","billing_class":"facility"},{"gross_charge":508.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TONSILS-PhHOS","code_information":[{"code":"2810799","type":"CDM"},{"code":"361","type":"RC"},{"code":"42826","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.75,"setting":"both","billing_class":"facility"},{"gross_charge":485.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ADENOIDS-PhHOS","code_information":[{"code":"2810800","type":"CDM"},{"code":"361","type":"RC"},{"code":"42830","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.75,"setting":"both","billing_class":"facility"},{"gross_charge":485.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ADENOIDS-PhHOS","code_information":[{"code":"2810801","type":"CDM"},{"code":"361","type":"RC"},{"code":"42831","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.25,"setting":"both","billing_class":"facility"},{"gross_charge":417.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ADENOIDS-PhHOS","code_information":[{"code":"2810802","type":"CDM"},{"code":"361","type":"RC"},{"code":"42835","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.75,"setting":"both","billing_class":"facility"},{"gross_charge":335.75,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL THROAT BLEEDING-PhHOS","code_information":[{"code":"2810803","type":"CDM"},{"code":"361","type":"RC"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.5,"setting":"both","billing_class":"facility"},{"gross_charge":328.5,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL THROAT BLEEDING-PhHOS","code_information":[{"code":"2810804","type":"CDM"},{"code":"361","type":"RC"},{"code":"42961","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.25,"setting":"both","billing_class":"facility"},{"gross_charge":819.25,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL THROAT BLEEDING-PhHOS","code_information":[{"code":"2810805","type":"CDM"},{"code":"361","type":"RC"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.5,"setting":"both","billing_class":"facility"},{"gross_charge":982.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAG RIGID TRNSO DX-PhHOS","code_information":[{"code":"2810806","type":"CDM"},{"code":"361","type":"RC"},{"code":"43191","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"facility"},{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGUS ENDO-PhHOS","code_information":[{"code":"2810807","type":"CDM"},{"code":"361","type":"RC"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"},{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH SC W/SUBMUCOUS INJ-PhHOS","code_information":[{"code":"2810808","type":"CDM"},{"code":"361","type":"RC"},{"code":"43201","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"setting":"both","billing_class":"facility"},{"gross_charge":203.0,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGUS ENDO BX-PhHOS","code_information":[{"code":"2810809","type":"CDM"},{"code":"361","type":"RC"},{"code":"43202","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"},{"gross_charge":220.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAG ENDOSC/LIGATION-PhHOS","code_information":[{"code":"2810810","type":"CDM"},{"code":"361","type":"RC"},{"code":"43205","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.5,"setting":"both","billing_class":"facility"},{"gross_charge":425.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGUS ENDO-PhHOS","code_information":[{"code":"2810811","type":"CDM"},{"code":"361","type":"RC"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"facility"},{"gross_charge":294.0,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH ENDO DILATION-PhHOS","code_information":[{"code":"2810812","type":"CDM"},{"code":"361","type":"RC"},{"code":"43220","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.75,"setting":"both","billing_class":"facility"},{"gross_charge":241.75,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH ENDO DILATION-PhHOS","code_information":[{"code":"2810813","type":"CDM"},{"code":"361","type":"RC"},{"code":"43226","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.5,"setting":"both","billing_class":"facility"},{"gross_charge":268.5,"setting":"both","billing_class":"professional"}]},{"description":"UPPR GI ENDO DIAGNOSIS-PhHOS","code_information":[{"code":"2810814","type":"CDM"},{"code":"361","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"},{"gross_charge":276.5,"setting":"both","billing_class":"professional"}]},{"description":"UPPR GI SC W/SUBMUC INJ-PhHOS","code_information":[{"code":"2810815","type":"CDM"},{"code":"361","type":"RC"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.75,"setting":"both","billing_class":"facility"},{"gross_charge":332.75,"setting":"both","billing_class":"professional"}]},{"description":"UPPER GI ENDO BX-PhHOS","code_information":[{"code":"2810816","type":"CDM"},{"code":"361","type":"RC"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.5,"setting":"both","billing_class":"facility"},{"gross_charge":326.5,"setting":"both","billing_class":"professional"}]},{"description":"UPPER GI ENDO & INJECT-PhHOS","code_information":[{"code":"2810817","type":"CDM"},{"code":"361","type":"RC"},{"code":"43243","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"setting":"both","billing_class":"facility"},{"gross_charge":507.0,"setting":"both","billing_class":"professional"}]},{"description":"UPPER GI ENDO/LIGATION-PhHOS","code_information":[{"code":"2810818","type":"CDM"},{"code":"361","type":"RC"},{"code":"43244","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"setting":"both","billing_class":"facility"},{"gross_charge":559.0,"setting":"both","billing_class":"professional"}]},{"description":"UPPR GI SCOPE DILATE STR-PhHOS","code_information":[{"code":"2810819","type":"CDM"},{"code":"361","type":"RC"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"setting":"both","billing_class":"facility"},{"gross_charge":357.0,"setting":"both","billing_class":"professional"}]},{"description":"PLACE GASTROSTOMY TUBE-PhHOS","code_information":[{"code":"2810820","type":"CDM"},{"code":"361","type":"RC"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"facility"},{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"UPPER GI ENDO-PhHOS","code_information":[{"code":"2810821","type":"CDM"},{"code":"361","type":"RC"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"facility"},{"gross_charge":380.5,"setting":"both","billing_class":"professional"}]},{"description":"UPPR GI ENDO/GU WIRE-PhHOS","code_information":[{"code":"2810822","type":"CDM"},{"code":"361","type":"RC"},{"code":"43248","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"setting":"both","billing_class":"facility"},{"gross_charge":357.0,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH ENDO DILATION-PhHOS","code_information":[{"code":"2810823","type":"CDM"},{"code":"361","type":"RC"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.5,"setting":"both","billing_class":"facility"},{"gross_charge":329.5,"setting":"both","billing_class":"professional"}]},{"description":"OPERATIVE UPPER GI ENDO-PhHOS","code_information":[{"code":"2810824","type":"CDM"},{"code":"361","type":"RC"},{"code":"43251","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.25,"setting":"both","billing_class":"facility"},{"gross_charge":414.25,"setting":"both","billing_class":"professional"}]},{"description":"OPERATIVE UPPER GI ENDO-PhHOS","code_information":[{"code":"2810825","type":"CDM"},{"code":"361","type":"RC"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.5,"setting":"both","billing_class":"facility"},{"gross_charge":534.5,"setting":"both","billing_class":"professional"}]},{"description":"ENDO CHOLANGIO-PhHOS","code_information":[{"code":"2810826","type":"CDM"},{"code":"361","type":"RC"},{"code":"43260","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"setting":"both","billing_class":"facility"},{"gross_charge":655.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDO CHOLANGIO-PhHOS","code_information":[{"code":"2810827","type":"CDM"},{"code":"361","type":"RC"},{"code":"43261","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.5,"setting":"both","billing_class":"facility"},{"gross_charge":687.5,"setting":"both","billing_class":"professional"}]},{"description":"ENDO CHOLANGIO-PhHOS","code_information":[{"code":"2810828","type":"CDM"},{"code":"361","type":"RC"},{"code":"43262","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"setting":"both","billing_class":"facility"},{"gross_charge":809.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDO CHOLANGIO-PhHOS","code_information":[{"code":"2810829","type":"CDM"},{"code":"361","type":"RC"},{"code":"43264","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"setting":"both","billing_class":"facility"},{"gross_charge":969.0,"setting":"both","billing_class":"professional"}]},{"description":"EGD ENDOSCOPIC STENT PL-PhHOS","code_information":[{"code":"2810830","type":"CDM"},{"code":"361","type":"RC"},{"code":"43266","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"setting":"both","billing_class":"facility"},{"gross_charge":452.0,"setting":"both","billing_class":"professional"}]},{"description":"EGD LES ABLATION-PhHOS","code_information":[{"code":"2810831","type":"CDM"},{"code":"361","type":"RC"},{"code":"43270","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.5,"setting":"both","billing_class":"facility"},{"gross_charge":423.5,"setting":"both","billing_class":"professional"}]},{"description":"LAP PARAESOPHAG HERN REP-PhHOS","code_information":[{"code":"2810833","type":"CDM"},{"code":"361","type":"RC"},{"code":"43281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2922.5,"setting":"both","billing_class":"facility"},{"gross_charge":2922.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF STOMACH-PhHOS","code_information":[{"code":"2810834","type":"CDM"},{"code":"361","type":"RC"},{"code":"43605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.0,"setting":"both","billing_class":"facility"},{"gross_charge":1574.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF STOMACH PARTIAL-PhHOS","code_information":[{"code":"2810835","type":"CDM"},{"code":"361","type":"RC"},{"code":"43631","type":"HCPCS"}],"standard_charges":[{"gross_charge":2725.5,"setting":"both","billing_class":"facility"},{"gross_charge":2725.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF STOMACH PARTIAL-PhHOS","code_information":[{"code":"2810836","type":"CDM"},{"code":"361","type":"RC"},{"code":"43635","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.25,"setting":"both","billing_class":"facility"},{"gross_charge":209.25,"setting":"both","billing_class":"professional"}]},{"description":"VAGOTOMY & PYLORUS REP-PhHOS","code_information":[{"code":"2810837","type":"CDM"},{"code":"361","type":"RC"},{"code":"43640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2217.5,"setting":"both","billing_class":"facility"},{"gross_charge":2217.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPE PROC STOM-PhHOS","code_information":[{"code":"2810838","type":"CDM"},{"code":"361","type":"RC"},{"code":"43659","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.0,"setting":"both","billing_class":"facility"},{"gross_charge":2652.0,"setting":"both","billing_class":"professional"}]},{"description":"NASAL/OROGASTRIC W/STENT-PhHOS","code_information":[{"code":"2810839","type":"CDM"},{"code":"361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE GASTROSTOMY TUBE-PhHOS","code_information":[{"code":"2810840","type":"CDM"},{"code":"361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"LAP PLACE GASTR ADJ BAND-PhHOS","code_information":[{"code":"2810841","type":"CDM"},{"code":"361","type":"RC"},{"code":"43770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.5,"setting":"both","billing_class":"facility"},{"gross_charge":2109.5,"setting":"both","billing_class":"professional"}]},{"description":"FUSION STOMACH & BOWEL-PhHOS","code_information":[{"code":"2810842","type":"CDM"},{"code":"361","type":"RC"},{"code":"43820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"setting":"both","billing_class":"facility"},{"gross_charge":2538.0,"setting":"both","billing_class":"professional"}]},{"description":"FUSION STOMACH & BOWEL-PhHOS","code_information":[{"code":"2810843","type":"CDM"},{"code":"361","type":"RC"},{"code":"43825","type":"HCPCS"}],"standard_charges":[{"gross_charge":2396.0,"setting":"both","billing_class":"facility"},{"gross_charge":2396.0,"setting":"both","billing_class":"professional"}]},{"description":"PLACE GASTROSTOMY TUBE-PhHOS","code_information":[{"code":"2810844","type":"CDM"},{"code":"361","type":"RC"},{"code":"43830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"setting":"both","billing_class":"facility"},{"gross_charge":1318.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF STOMACH LES-PhHOS","code_information":[{"code":"2810845","type":"CDM"},{"code":"361","type":"RC"},{"code":"43840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2553.25,"setting":"both","billing_class":"facility"},{"gross_charge":2553.25,"setting":"both","billing_class":"professional"}]},{"description":"FREEING BOWEL ADHESION-PhHOS","code_information":[{"code":"2810846","type":"CDM"},{"code":"361","type":"RC"},{"code":"44005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.5,"setting":"both","billing_class":"facility"},{"gross_charge":2057.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION SMALL BOWEL-PhHOS","code_information":[{"code":"2810847","type":"CDM"},{"code":"361","type":"RC"},{"code":"44010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.25,"setting":"both","billing_class":"facility"},{"gross_charge":1640.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT NEEDLE CATH BOWEL-PhHOS","code_information":[{"code":"2810848","type":"CDM"},{"code":"361","type":"RC"},{"code":"44015","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"DECOMPR SMALL BOWEL-PhHOS","code_information":[{"code":"2810849","type":"CDM"},{"code":"361","type":"RC"},{"code":"44021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.25,"setting":"both","billing_class":"facility"},{"gross_charge":1837.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SMALL INTESTINE-PhHOS","code_information":[{"code":"2810850","type":"CDM"},{"code":"361","type":"RC"},{"code":"44120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.25,"setting":"both","billing_class":"facility"},{"gross_charge":2298.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SMALL INTESTINE-PhHOS","code_information":[{"code":"2810851","type":"CDM"},{"code":"361","type":"RC"},{"code":"44121","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"setting":"both","billing_class":"facility"},{"gross_charge":452.0,"setting":"both","billing_class":"professional"}]},{"description":"BOWEL TO BOWEL FUSION-PhHOS","code_information":[{"code":"2810852","type":"CDM"},{"code":"361","type":"RC"},{"code":"44130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2445.0,"setting":"both","billing_class":"facility"},{"gross_charge":2445.0,"setting":"both","billing_class":"professional"}]},{"description":"MOBILIZATION OF COLON-PhHOS","code_information":[{"code":"2810853","type":"CDM"},{"code":"361","type":"RC"},{"code":"44139","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.5,"setting":"both","billing_class":"facility"},{"gross_charge":225.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810854","type":"CDM"},{"code":"361","type":"RC"},{"code":"44140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.5,"setting":"both","billing_class":"facility"},{"gross_charge":2524.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810855","type":"CDM"},{"code":"361","type":"RC"},{"code":"44141","type":"HCPCS"}],"standard_charges":[{"gross_charge":3389.5,"setting":"both","billing_class":"facility"},{"gross_charge":3389.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810856","type":"CDM"},{"code":"361","type":"RC"},{"code":"44143","type":"HCPCS"}],"standard_charges":[{"gross_charge":3137.75,"setting":"both","billing_class":"facility"},{"gross_charge":3137.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810857","type":"CDM"},{"code":"361","type":"RC"},{"code":"44144","type":"HCPCS"}],"standard_charges":[{"gross_charge":3299.75,"setting":"both","billing_class":"facility"},{"gross_charge":3299.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810858","type":"CDM"},{"code":"361","type":"RC"},{"code":"44145","type":"HCPCS"}],"standard_charges":[{"gross_charge":3122.25,"setting":"both","billing_class":"facility"},{"gross_charge":3122.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810859","type":"CDM"},{"code":"361","type":"RC"},{"code":"44146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3932.25,"setting":"both","billing_class":"facility"},{"gross_charge":3932.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF COLON-PhHOS","code_information":[{"code":"2810860","type":"CDM"},{"code":"361","type":"RC"},{"code":"44147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3650.75,"setting":"both","billing_class":"facility"},{"gross_charge":3650.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF COLON-PhHOS","code_information":[{"code":"2810861","type":"CDM"},{"code":"361","type":"RC"},{"code":"44150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3543.5,"setting":"both","billing_class":"facility"},{"gross_charge":3543.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF COLON-PhHOS","code_information":[{"code":"2810862","type":"CDM"},{"code":"361","type":"RC"},{"code":"44160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2339.0,"setting":"both","billing_class":"facility"},{"gross_charge":2339.0,"setting":"both","billing_class":"professional"}]},{"description":"LAP ENTEROLYSIS-PhHOS","code_information":[{"code":"2810863","type":"CDM"},{"code":"361","type":"RC"},{"code":"44180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"setting":"both","billing_class":"facility"},{"gross_charge":1730.0,"setting":"both","billing_class":"professional"}]},{"description":"LAP ILEO/JEJUNO-STOMY-PhHOS","code_information":[{"code":"2810864","type":"CDM"},{"code":"361","type":"RC"},{"code":"44187","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.25,"setting":"both","billing_class":"facility"},{"gross_charge":2050.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP COLOSTOMY-PhHOS","code_information":[{"code":"2810865","type":"CDM"},{"code":"361","type":"RC"},{"code":"44188","type":"HCPCS"}],"standard_charges":[{"gross_charge":2267.5,"setting":"both","billing_class":"facility"},{"gross_charge":2267.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO PARTIAL COLECT-PhHOS","code_information":[{"code":"2810866","type":"CDM"},{"code":"361","type":"RC"},{"code":"44204","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.25,"setting":"both","billing_class":"facility"},{"gross_charge":2857.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP COLECT PART W/ILEUM-PhHOS","code_information":[{"code":"2810867","type":"CDM"},{"code":"361","type":"RC"},{"code":"44205","type":"HCPCS"}],"standard_charges":[{"gross_charge":2526.75,"setting":"both","billing_class":"facility"},{"gross_charge":2526.75,"setting":"both","billing_class":"professional"}]},{"description":"LAP PART COLECT W/STOMA-PhHOS","code_information":[{"code":"2810868","type":"CDM"},{"code":"361","type":"RC"},{"code":"44206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3314.0,"setting":"both","billing_class":"facility"},{"gross_charge":3314.0,"setting":"both","billing_class":"professional"}]},{"description":"L COLECT/COLOPROCTOST-PhHOS","code_information":[{"code":"2810869","type":"CDM"},{"code":"361","type":"RC"},{"code":"44207","type":"HCPCS"}],"standard_charges":[{"gross_charge":3376.25,"setting":"both","billing_class":"facility"},{"gross_charge":3376.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP MOB SPLENIC FL ADDL-PhHOS","code_information":[{"code":"2810870","type":"CDM"},{"code":"361","type":"RC"},{"code":"44213","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"setting":"both","billing_class":"facility"},{"gross_charge":351.0,"setting":"both","billing_class":"professional"}]},{"description":"LAP CLOSE ENTEROSTOMY-PhHOS","code_information":[{"code":"2810871","type":"CDM"},{"code":"361","type":"RC"},{"code":"44227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3096.75,"setting":"both","billing_class":"facility"},{"gross_charge":3096.75,"setting":"both","billing_class":"professional"}]},{"description":"OPEN BOWEL TO SK-PhHOS","code_information":[{"code":"2810872","type":"CDM"},{"code":"361","type":"RC"},{"code":"44300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.25,"setting":"both","billing_class":"facility"},{"gross_charge":1587.25,"setting":"both","billing_class":"professional"}]},{"description":"ILEOSTOMY/JEJUNOSTOMY-PhHOS","code_information":[{"code":"2810873","type":"CDM"},{"code":"361","type":"RC"},{"code":"44310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.75,"setting":"both","billing_class":"facility"},{"gross_charge":2478.75,"setting":"both","billing_class":"professional"}]},{"description":"COLOSTOMY-PhHOS","code_information":[{"code":"2810874","type":"CDM"},{"code":"361","type":"RC"},{"code":"44320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.75,"setting":"both","billing_class":"facility"},{"gross_charge":2270.75,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF COLOSTOMY-PhHOS","code_information":[{"code":"2810875","type":"CDM"},{"code":"361","type":"RC"},{"code":"44346","type":"HCPCS"}],"standard_charges":[{"gross_charge":2238.0,"setting":"both","billing_class":"facility"},{"gross_charge":2238.0,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO-PhHOS","code_information":[{"code":"2810876","type":"CDM"},{"code":"361","type":"RC"},{"code":"44360","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.5,"setting":"both","billing_class":"facility"},{"gross_charge":279.5,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO/BX-PhHOS","code_information":[{"code":"2810877","type":"CDM"},{"code":"361","type":"RC"},{"code":"44361","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"facility"},{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO/BX-PhHOS","code_information":[{"code":"2810878","type":"CDM"},{"code":"361","type":"RC"},{"code":"44377","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"setting":"both","billing_class":"facility"},{"gross_charge":608.0,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO-PhHOS","code_information":[{"code":"2810879","type":"CDM"},{"code":"361","type":"RC"},{"code":"44380","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.75,"setting":"both","billing_class":"facility"},{"gross_charge":128.75,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO BR/WA-PhHOS","code_information":[{"code":"2810880","type":"CDM"},{"code":"361","type":"RC"},{"code":"44381","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.25,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"SMALL BOWEL ENDO-PhHOS","code_information":[{"code":"2810881","type":"CDM"},{"code":"361","type":"RC"},{"code":"44382","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"setting":"both","billing_class":"facility"},{"gross_charge":155.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDO BOWEL POUCH/BIOP-PhHOS","code_information":[{"code":"2810882","type":"CDM"},{"code":"361","type":"RC"},{"code":"44386","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"setting":"both","billing_class":"facility"},{"gross_charge":297.0,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC-PhHOS","code_information":[{"code":"2810883","type":"CDM"},{"code":"361","type":"RC"},{"code":"44388","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.25,"setting":"both","billing_class":"facility"},{"gross_charge":317.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC WITH BX-PhHOS","code_information":[{"code":"2810884","type":"CDM"},{"code":"361","type":"RC"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"setting":"both","billing_class":"facility"},{"gross_charge":353.0,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC FOR BLEEDING-PhHOS","code_information":[{"code":"2810885","type":"CDM"},{"code":"361","type":"RC"},{"code":"44391","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.5,"setting":"both","billing_class":"facility"},{"gross_charge":478.5,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC & POLYPECTOMY-PhHOS","code_information":[{"code":"2810886","type":"CDM"},{"code":"361","type":"RC"},{"code":"44392","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.25,"setting":"both","billing_class":"facility"},{"gross_charge":420.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC W/SNARE-PhHOS","code_information":[{"code":"2810887","type":"CDM"},{"code":"361","type":"RC"},{"code":"44394","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.75,"setting":"both","billing_class":"facility"},{"gross_charge":486.75,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC W/INJ-PhHOS","code_information":[{"code":"2810888","type":"CDM"},{"code":"361","type":"RC"},{"code":"44404","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"facility"},{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC W/DILATION-PhHOS","code_information":[{"code":"2810889","type":"CDM"},{"code":"361","type":"RC"},{"code":"44405","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"setting":"both","billing_class":"facility"},{"gross_charge":354.0,"setting":"both","billing_class":"professional"}]},{"description":"INTRO GASTROINTEST TUBE-PhHOS","code_information":[{"code":"2810890","type":"CDM"},{"code":"361","type":"RC"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"},{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE SMALL INTESTINE-PhHOS","code_information":[{"code":"2810891","type":"CDM"},{"code":"361","type":"RC"},{"code":"44602","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.0,"setting":"both","billing_class":"facility"},{"gross_charge":2645.0,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE SMALL INTESTINE-PhHOS","code_information":[{"code":"2810892","type":"CDM"},{"code":"361","type":"RC"},{"code":"44603","type":"HCPCS"}],"standard_charges":[{"gross_charge":3039.75,"setting":"both","billing_class":"facility"},{"gross_charge":3039.75,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE LARGE INTESTINE-PhHOS","code_information":[{"code":"2810893","type":"CDM"},{"code":"361","type":"RC"},{"code":"44604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.25,"setting":"both","billing_class":"facility"},{"gross_charge":1996.25,"setting":"both","billing_class":"professional"}]},{"description":"INTESTINAL STRICTUROPL-PhHOS","code_information":[{"code":"2810894","type":"CDM"},{"code":"361","type":"RC"},{"code":"44615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1997.25,"setting":"both","billing_class":"facility"},{"gross_charge":1997.25,"setting":"both","billing_class":"professional"}]},{"description":"REP BOWEL OPENING-PhHOS","code_information":[{"code":"2810895","type":"CDM"},{"code":"361","type":"RC"},{"code":"44620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.25,"setting":"both","billing_class":"facility"},{"gross_charge":1638.25,"setting":"both","billing_class":"professional"}]},{"description":"REP BOWEL OPENING-PhHOS","code_information":[{"code":"2810896","type":"CDM"},{"code":"361","type":"RC"},{"code":"44625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1923.75,"setting":"both","billing_class":"facility"},{"gross_charge":1923.75,"setting":"both","billing_class":"professional"}]},{"description":"REP BOWEL OPENING-PhHOS","code_information":[{"code":"2810897","type":"CDM"},{"code":"361","type":"RC"},{"code":"44626","type":"HCPCS"}],"standard_charges":[{"gross_charge":3017.25,"setting":"both","billing_class":"facility"},{"gross_charge":3017.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN APP ABSCESS OPEN-PhHOS","code_information":[{"code":"2810898","type":"CDM"},{"code":"361","type":"RC"},{"code":"44900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.75,"setting":"both","billing_class":"facility"},{"gross_charge":1462.75,"setting":"both","billing_class":"professional"}]},{"description":"APPENDECTOMY-PhHOS","code_information":[{"code":"2810899","type":"CDM"},{"code":"361","type":"RC"},{"code":"44950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1207.75,"setting":"both","billing_class":"facility"},{"gross_charge":1207.75,"setting":"both","billing_class":"professional"}]},{"description":"APPENDECTOMY ADDL-PhHOS","code_information":[{"code":"2810900","type":"CDM"},{"code":"361","type":"RC"},{"code":"44955","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"facility"},{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"APPENDECTOMY-PhHOS","code_information":[{"code":"2810901","type":"CDM"},{"code":"361","type":"RC"},{"code":"44960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.25,"setting":"both","billing_class":"facility"},{"gross_charge":1644.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC APPENDECTOMY-PhHOS","code_information":[{"code":"2810902","type":"CDM"},{"code":"361","type":"RC"},{"code":"44970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.25,"setting":"both","billing_class":"facility"},{"gross_charge":1134.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN RECTAL ABSCESS-PhHOS","code_information":[{"code":"2810903","type":"CDM"},{"code":"361","type":"RC"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF RECTUM-PhHOS","code_information":[{"code":"2810904","type":"CDM"},{"code":"361","type":"RC"},{"code":"45100","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.25,"setting":"both","billing_class":"facility"},{"gross_charge":572.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF RECTUM-PhHOS","code_information":[{"code":"2810905","type":"CDM"},{"code":"361","type":"RC"},{"code":"45110","type":"HCPCS"}],"standard_charges":[{"gross_charge":3508.0,"setting":"both","billing_class":"facility"},{"gross_charge":3508.0,"setting":"both","billing_class":"professional"}]},{"description":"EX RECT TUM TRANSANAL-PhHOS","code_information":[{"code":"2810906","type":"CDM"},{"code":"361","type":"RC"},{"code":"45171","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.75,"setting":"both","billing_class":"facility"},{"gross_charge":1151.75,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSC DX-PhHOS","code_information":[{"code":"2810907","type":"CDM"},{"code":"361","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"facility"},{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSC W/BX-PhHOS","code_information":[{"code":"2810908","type":"CDM"},{"code":"361","type":"RC"},{"code":"45305","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSC FB-PhHOS","code_information":[{"code":"2810909","type":"CDM"},{"code":"361","type":"RC"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"facility"},{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSC REM-PhHOS","code_information":[{"code":"2810910","type":"CDM"},{"code":"361","type":"RC"},{"code":"45309","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.5,"setting":"both","billing_class":"facility"},{"gross_charge":177.5,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSC ABLATE-PhHOS","code_information":[{"code":"2810911","type":"CDM"},{"code":"361","type":"RC"},{"code":"45320","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC SIGMOIDOSC-PhHOS","code_information":[{"code":"2810912","type":"CDM"},{"code":"361","type":"RC"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC AND BX-PhHOS","code_information":[{"code":"2810913","type":"CDM"},{"code":"361","type":"RC"},{"code":"45331","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"setting":"both","billing_class":"facility"},{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC W/FB REM-PhHOS","code_information":[{"code":"2810914","type":"CDM"},{"code":"361","type":"RC"},{"code":"45332","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"facility"},{"gross_charge":212.25,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC & POLYPECT-PhHOS","code_information":[{"code":"2810915","type":"CDM"},{"code":"361","type":"RC"},{"code":"45333","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.25,"setting":"both","billing_class":"facility"},{"gross_charge":210.25,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC FOR BLEEDING-PhHOS","code_information":[{"code":"2810916","type":"CDM"},{"code":"361","type":"RC"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"facility"},{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC W/SUBMUC INJ-PhHOS","code_information":[{"code":"2810917","type":"CDM"},{"code":"361","type":"RC"},{"code":"45335","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC & DECOMPR-PhHOS","code_information":[{"code":"2810918","type":"CDM"},{"code":"361","type":"RC"},{"code":"45337","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","billing_class":"facility"},{"gross_charge":272.5,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSC W/TUMR REM-PhHOS","code_information":[{"code":"2810919","type":"CDM"},{"code":"361","type":"RC"},{"code":"45338","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.5,"setting":"both","billing_class":"facility"},{"gross_charge":268.5,"setting":"both","billing_class":"professional"}]},{"description":"SIG W/BALLOON DILATION-PhHOS","code_information":[{"code":"2810920","type":"CDM"},{"code":"361","type":"RC"},{"code":"45340","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.5,"setting":"both","billing_class":"facility"},{"gross_charge":222.5,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC COLONOSC-PhHOS","code_information":[{"code":"2810921","type":"CDM"},{"code":"361","type":"RC"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"facility"},{"gross_charge":412.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC W/FB REM-PhHOS","code_information":[{"code":"2810922","type":"CDM"},{"code":"361","type":"RC"},{"code":"45379","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"setting":"both","billing_class":"facility"},{"gross_charge":498.0,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC AND BX-PhHOS","code_information":[{"code":"2810923","type":"CDM"},{"code":"361","type":"RC"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.25,"setting":"both","billing_class":"facility"},{"gross_charge":775.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC SUBMUCOUS INJ-PhHOS","code_information":[{"code":"2810924","type":"CDM"},{"code":"361","type":"RC"},{"code":"45381","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.25,"setting":"both","billing_class":"facility"},{"gross_charge":467.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC/CONTRL BLEEDING-PhHOS","code_information":[{"code":"2810925","type":"CDM"},{"code":"361","type":"RC"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.5,"setting":"both","billing_class":"facility"},{"gross_charge":625.5,"setting":"both","billing_class":"professional"}]},{"description":"LES REM COLONOSC-PhHOS","code_information":[{"code":"2810926","type":"CDM"},{"code":"361","type":"RC"},{"code":"45384","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.25,"setting":"both","billing_class":"facility"},{"gross_charge":514.25,"setting":"both","billing_class":"professional"}]},{"description":"LES REM COLONOSC-PhHOS","code_information":[{"code":"2810927","type":"CDM"},{"code":"361","type":"RC"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.5,"setting":"both","billing_class":"facility"},{"gross_charge":583.5,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC DIL STRICTURE-PhHOS","code_information":[{"code":"2810928","type":"CDM"},{"code":"361","type":"RC"},{"code":"45386","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"setting":"both","billing_class":"facility"},{"gross_charge":506.0,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSC W/ABLATION-PhHOS","code_information":[{"code":"2810929","type":"CDM"},{"code":"361","type":"RC"},{"code":"45388","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.25,"setting":"both","billing_class":"facility"},{"gross_charge":519.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP REM RECTUM W/POUCH-PhHOS","code_information":[{"code":"2810930","type":"CDM"},{"code":"361","type":"RC"},{"code":"45397","type":"HCPCS"}],"standard_charges":[{"gross_charge":3993.5,"setting":"both","billing_class":"facility"},{"gross_charge":3993.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATION ANAL SPHINCTER-PhHOS","code_information":[{"code":"2810931","type":"CDM"},{"code":"361","type":"RC"},{"code":"45905","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.5,"setting":"both","billing_class":"facility"},{"gross_charge":330.5,"setting":"both","billing_class":"professional"}]},{"description":"REM RECTAL OBSTRUCTION-PhHOS","code_information":[{"code":"2810932","type":"CDM"},{"code":"361","type":"RC"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.5,"setting":"both","billing_class":"facility"},{"gross_charge":431.5,"setting":"both","billing_class":"professional"}]},{"description":"SURG DX EXAM ANORECTAL-PhHOS","code_information":[{"code":"2810933","type":"CDM"},{"code":"361","type":"RC"},{"code":"45990","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"},{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"PLACEMENT OF SETON-PhHOS","code_information":[{"code":"2810934","type":"CDM"},{"code":"361","type":"RC"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.5,"setting":"both","billing_class":"facility"},{"gross_charge":432.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION RECTAL ABSCESS-PhHOS","code_information":[{"code":"2810935","type":"CDM"},{"code":"361","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.5,"setting":"both","billing_class":"facility"},{"gross_charge":790.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION RECTAL ABSCESS-PhHOS","code_information":[{"code":"2810936","type":"CDM"},{"code":"361","type":"RC"},{"code":"46045","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.5,"setting":"both","billing_class":"facility"},{"gross_charge":829.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION ANAL ABSCESS-PhHOS","code_information":[{"code":"2810937","type":"CDM"},{"code":"361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"facility"},{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION RECTAL ABSCESS-PhHOS","code_information":[{"code":"2810938","type":"CDM"},{"code":"361","type":"RC"},{"code":"46060","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"setting":"both","billing_class":"facility"},{"gross_charge":912.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION ANAL SPHINCTER-PhHOS","code_information":[{"code":"2810939","type":"CDM"},{"code":"361","type":"RC"},{"code":"46080","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"facility"},{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE EX HEMORRHOID-PhHOS","code_information":[{"code":"2810940","type":"CDM"},{"code":"361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL FISSURE-PhHOS","code_information":[{"code":"2810941","type":"CDM"},{"code":"361","type":"RC"},{"code":"46200","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.75,"setting":"both","billing_class":"facility"},{"gross_charge":598.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL TAG-PhHOS","code_information":[{"code":"2810942","type":"CDM"},{"code":"361","type":"RC"},{"code":"46220","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.5,"setting":"both","billing_class":"facility"},{"gross_charge":219.5,"setting":"both","billing_class":"professional"}]},{"description":"LIGATION OF HEMORRHOID-PhHOS","code_information":[{"code":"2810943","type":"CDM"},{"code":"361","type":"RC"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"facility"},{"gross_charge":288.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL TAGS-PhHOS","code_information":[{"code":"2810944","type":"CDM"},{"code":"361","type":"RC"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.25,"setting":"both","billing_class":"facility"},{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"HEMORRHOIDECTOMY-PhHOS","code_information":[{"code":"2810945","type":"CDM"},{"code":"361","type":"RC"},{"code":"46250","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"setting":"both","billing_class":"facility"},{"gross_charge":601.0,"setting":"both","billing_class":"professional"}]},{"description":"HEMORRHOIDECTOMY-PhHOS","code_information":[{"code":"2810946","type":"CDM"},{"code":"361","type":"RC"},{"code":"46255","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.25,"setting":"both","billing_class":"facility"},{"gross_charge":673.25,"setting":"both","billing_class":"professional"}]},{"description":"HEMORRHOIDECTOMY-PhHOS","code_information":[{"code":"2810947","type":"CDM"},{"code":"361","type":"RC"},{"code":"46260","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.75,"setting":"both","billing_class":"facility"},{"gross_charge":904.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL FISTULA-PhHOS","code_information":[{"code":"2810948","type":"CDM"},{"code":"361","type":"RC"},{"code":"46270","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.75,"setting":"both","billing_class":"facility"},{"gross_charge":749.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL FISTULA-PhHOS","code_information":[{"code":"2810949","type":"CDM"},{"code":"361","type":"RC"},{"code":"46280","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"setting":"both","billing_class":"facility"},{"gross_charge":865.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF HEMORRHOID CLOT-PhHOS","code_information":[{"code":"2810950","type":"CDM"},{"code":"361","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"facility"},{"gross_charge":212.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV ANAL MUSC-PhHOS","code_information":[{"code":"2810951","type":"CDM"},{"code":"361","type":"RC"},{"code":"46505","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.75,"setting":"both","billing_class":"facility"},{"gross_charge":439.75,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC ANOSCOPY-PhHOS","code_information":[{"code":"2810952","type":"CDM"},{"code":"361","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY AND DILATION-PhHOS","code_information":[{"code":"2810953","type":"CDM"},{"code":"361","type":"RC"},{"code":"46604","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"facility"},{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY-PhHOS","code_information":[{"code":"2810954","type":"CDM"},{"code":"361","type":"RC"},{"code":"46611","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"facility"},{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"REP ANORECTAL FIST W/PL-PhHOS","code_information":[{"code":"2810955","type":"CDM"},{"code":"361","type":"RC"},{"code":"46707","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.5,"setting":"both","billing_class":"facility"},{"gross_charge":883.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION ANAL LES-PhHOS","code_information":[{"code":"2810956","type":"CDM"},{"code":"361","type":"RC"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"facility"},{"gross_charge":264.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION ANAL LES-PhHOS","code_information":[{"code":"2810957","type":"CDM"},{"code":"361","type":"RC"},{"code":"46910","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.25,"setting":"both","billing_class":"facility"},{"gross_charge":258.25,"setting":"both","billing_class":"professional"}]},{"description":"CRYOSURG ANAL LES-PhHOS","code_information":[{"code":"2810958","type":"CDM"},{"code":"361","type":"RC"},{"code":"46916","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.5,"setting":"both","billing_class":"facility"},{"gross_charge":274.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF ANAL LES-PhHOS","code_information":[{"code":"2810959","type":"CDM"},{"code":"361","type":"RC"},{"code":"46922","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.25,"setting":"both","billing_class":"facility"},{"gross_charge":260.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION ANAL LES-PhHOS","code_information":[{"code":"2810960","type":"CDM"},{"code":"361","type":"RC"},{"code":"46924","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"setting":"both","billing_class":"facility"},{"gross_charge":352.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST INTERNAL HEMORRHOID-PhHOS","code_information":[{"code":"2810961","type":"CDM"},{"code":"361","type":"RC"},{"code":"46930","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.25,"setting":"both","billing_class":"facility"},{"gross_charge":310.25,"setting":"both","billing_class":"professional"}]},{"description":"LIGATION OF HEMORRHOIDS-PhHOS","code_information":[{"code":"2810962","type":"CDM"},{"code":"361","type":"RC"},{"code":"46946","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","billing_class":"facility"},{"gross_charge":433.5,"setting":"both","billing_class":"professional"}]},{"description":"HEMORRHOIDOPEXY STAPLE-PhHOS","code_information":[{"code":"2810963","type":"CDM"},{"code":"361","type":"RC"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.5,"setting":"both","billing_class":"facility"},{"gross_charge":728.5,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE BX OF LIVER-PhHOS","code_information":[{"code":"2810964","type":"CDM"},{"code":"361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.25,"setting":"both","billing_class":"facility"},{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE BX LIVER ADD-ON-PhHOS","code_information":[{"code":"2810965","type":"CDM"},{"code":"361","type":"RC"},{"code":"47001","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"facility"},{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"OPEN DRAINAGE LIVER LES-PhHOS","code_information":[{"code":"2810966","type":"CDM"},{"code":"361","type":"RC"},{"code":"47010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2266.5,"setting":"both","billing_class":"facility"},{"gross_charge":2266.5,"setting":"both","billing_class":"professional"}]},{"description":"WEDGE BX OF LIVER-PhHOS","code_information":[{"code":"2810967","type":"CDM"},{"code":"361","type":"RC"},{"code":"47100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1617.75,"setting":"both","billing_class":"facility"},{"gross_charge":1617.75,"setting":"both","billing_class":"professional"}]},{"description":"REP LIVER WND-PhHOS","code_information":[{"code":"2810968","type":"CDM"},{"code":"361","type":"RC"},{"code":"47350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.75,"setting":"both","billing_class":"facility"},{"gross_charge":2579.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION GALLBLADDER-PhHOS","code_information":[{"code":"2810969","type":"CDM"},{"code":"361","type":"RC"},{"code":"47480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.75,"setting":"both","billing_class":"facility"},{"gross_charge":1659.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION GALLBLADDER-PhHOS","code_information":[{"code":"2810970","type":"CDM"},{"code":"361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.25,"setting":"both","billing_class":"facility"},{"gross_charge":615.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC CHOLECYSTECTOMY-PhHOS","code_information":[{"code":"2810972","type":"CDM"},{"code":"361","type":"RC"},{"code":"47562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.75,"setting":"both","billing_class":"facility"},{"gross_charge":1259.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO CHOLECYSTECT/GR-PhHOS","code_information":[{"code":"2810973","type":"CDM"},{"code":"361","type":"RC"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.5,"setting":"both","billing_class":"facility"},{"gross_charge":1346.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF GALLBLADDER-PhHOS","code_information":[{"code":"2810974","type":"CDM"},{"code":"361","type":"RC"},{"code":"47600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2011.5,"setting":"both","billing_class":"facility"},{"gross_charge":2011.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF GALLBLADDER-PhHOS","code_information":[{"code":"2810975","type":"CDM"},{"code":"361","type":"RC"},{"code":"47605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2116.5,"setting":"both","billing_class":"facility"},{"gross_charge":2116.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF GALLBLADDER-PhHOS","code_information":[{"code":"2810976","type":"CDM"},{"code":"361","type":"RC"},{"code":"47610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.25,"setting":"both","billing_class":"facility"},{"gross_charge":2358.25,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORATION OF ABDOMEN-PhHOS","code_information":[{"code":"2810977","type":"CDM"},{"code":"361","type":"RC"},{"code":"49000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.5,"setting":"both","billing_class":"facility"},{"gross_charge":1451.5,"setting":"both","billing_class":"professional"}]},{"description":"REOPENING OF ABDOMEN-PhHOS","code_information":[{"code":"2810978","type":"CDM"},{"code":"361","type":"RC"},{"code":"49002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.75,"setting":"both","billing_class":"facility"},{"gross_charge":1966.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN ABD ABSCESS-PhHOS","code_information":[{"code":"2810979","type":"CDM"},{"code":"361","type":"RC"},{"code":"49020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2988.75,"setting":"both","billing_class":"facility"},{"gross_charge":2988.75,"setting":"both","billing_class":"professional"}]},{"description":"ABD PARACENTESIS-PhHOS","code_information":[{"code":"2810980","type":"CDM"},{"code":"361","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"PERITONEAL LAVAGE-PhHOS","code_information":[{"code":"2810981","type":"CDM"},{"code":"361","type":"RC"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"BX ABD MASS-PhHOS","code_information":[{"code":"2810982","type":"CDM"},{"code":"361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.25,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC/DSTR NTRA-ABD 5CM/<-PhHOS","code_information":[{"code":"2810983","type":"CDM"},{"code":"360","type":"RC"},{"code":"49186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.25,"setting":"both","billing_class":"facility"},{"gross_charge":1496.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF OMENTUM-PhHOS","code_information":[{"code":"2810984","type":"CDM"},{"code":"361","type":"RC"},{"code":"49255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.5,"setting":"both","billing_class":"facility"},{"gross_charge":1496.5,"setting":"both","billing_class":"professional"}]},{"description":"DIAG LAPARO SEP PROC-PhHOS","code_information":[{"code":"2810985","type":"CDM"},{"code":"361","type":"RC"},{"code":"49320","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.25,"setting":"both","billing_class":"facility"},{"gross_charge":619.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC BX-PhHOS","code_information":[{"code":"2810986","type":"CDM"},{"code":"361","type":"RC"},{"code":"49321","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"setting":"both","billing_class":"facility"},{"gross_charge":657.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC ASPIRATION-PhHOS","code_information":[{"code":"2810987","type":"CDM"},{"code":"361","type":"RC"},{"code":"49322","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.75,"setting":"both","billing_class":"facility"},{"gross_charge":700.75,"setting":"both","billing_class":"professional"}]},{"description":"REPL DUOD/JEJ TUBE PERC-PhHOS","code_information":[{"code":"2810988","type":"CDM"},{"code":"361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR ING HERN INIT REDUCE-PhHOS","code_information":[{"code":"2810989","type":"CDM"},{"code":"361","type":"RC"},{"code":"49500","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.25,"setting":"both","billing_class":"facility"},{"gross_charge":773.25,"setting":"both","billing_class":"professional"}]},{"description":"PRP HERN INIT REDUC >5YR-PhHOS","code_information":[{"code":"2810990","type":"CDM"},{"code":"361","type":"RC"},{"code":"49505","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.5,"setting":"both","billing_class":"facility"},{"gross_charge":983.5,"setting":"both","billing_class":"professional"}]},{"description":"PRP I/HERN INIT BL >5YR-PhHOS","code_information":[{"code":"2810991","type":"CDM"},{"code":"361","type":"RC"},{"code":"49507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.75,"setting":"both","billing_class":"facility"},{"gross_charge":1105.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR ING HERN REDUCE-PhHOS","code_information":[{"code":"2810992","type":"CDM"},{"code":"361","type":"RC"},{"code":"49520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.5,"setting":"both","billing_class":"facility"},{"gross_charge":1191.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR ING HERN BLED-PhHOS","code_information":[{"code":"2810993","type":"CDM"},{"code":"361","type":"RC"},{"code":"49521","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.5,"setting":"both","billing_class":"facility"},{"gross_charge":1348.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR ING HERN SLIDING-PhHOS","code_information":[{"code":"2810994","type":"CDM"},{"code":"361","type":"RC"},{"code":"49525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"setting":"both","billing_class":"facility"},{"gross_charge":1061.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR FEM HERN INIT REDUCE-PhHOS","code_information":[{"code":"2810995","type":"CDM"},{"code":"361","type":"RC"},{"code":"49550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.5,"setting":"both","billing_class":"facility"},{"gross_charge":1087.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR FEM HERN INIT BL-PhHOS","code_information":[{"code":"2810996","type":"CDM"},{"code":"361","type":"RC"},{"code":"49553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1207.75,"setting":"both","billing_class":"facility"},{"gross_charge":1207.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR FEM HERN REDUCE-PhHOS","code_information":[{"code":"2810997","type":"CDM"},{"code":"361","type":"RC"},{"code":"49555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1126.25,"setting":"both","billing_class":"facility"},{"gross_charge":1126.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO HERN REP INITIAL-PhHOS","code_information":[{"code":"2811009","type":"CDM"},{"code":"361","type":"RC"},{"code":"49650","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"setting":"both","billing_class":"facility"},{"gross_charge":856.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO HERN REP RECUR-PhHOS","code_information":[{"code":"2811010","type":"CDM"},{"code":"361","type":"RC"},{"code":"49651","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"setting":"both","billing_class":"facility"},{"gross_charge":1117.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF ABD WALL-PhHOS","code_information":[{"code":"2811017","type":"CDM"},{"code":"361","type":"RC"},{"code":"49900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.5,"setting":"both","billing_class":"facility"},{"gross_charge":1544.5,"setting":"both","billing_class":"professional"}]},{"description":"NJX PX NFROSGRM &/URTRGR-PhHOS","code_information":[{"code":"2811018","type":"CDM"},{"code":"361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"},{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"KIDNEY ENDO-PhHOS","code_information":[{"code":"2811019","type":"CDM"},{"code":"361","type":"RC"},{"code":"50575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.25,"setting":"both","billing_class":"facility"},{"gross_charge":1328.25,"setting":"both","billing_class":"professional"}]},{"description":"FRAGMENTING KIDNEY STONE-PhHOS","code_information":[{"code":"2811020","type":"CDM"},{"code":"361","type":"RC"},{"code":"50590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.5,"setting":"both","billing_class":"facility"},{"gross_charge":1142.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PX URINARY SYST-PhHOS","code_information":[{"code":"2811021","type":"CDM"},{"code":"361","type":"RC"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.25,"setting":"both","billing_class":"facility"},{"gross_charge":868.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISE & DRAIN BLADDER-PhHOS","code_information":[{"code":"2811022","type":"CDM"},{"code":"361","type":"RC"},{"code":"51040","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.5,"setting":"both","billing_class":"facility"},{"gross_charge":535.5,"setting":"both","billing_class":"professional"}]},{"description":"INC BLADD/DRAIN URETER-PhHOS","code_information":[{"code":"2811023","type":"CDM"},{"code":"361","type":"RC"},{"code":"51045","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.75,"setting":"both","billing_class":"facility"},{"gross_charge":902.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOLITHOTOMY W/STON REM-PhHO","code_information":[{"code":"2811024","type":"CDM"},{"code":"361","type":"RC"},{"code":"51050","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.25,"setting":"both","billing_class":"facility"},{"gross_charge":871.25,"setting":"both","billing_class":"professional"}]},{"description":"INJECT FOR BLADDER XRAY-PhHOS","code_information":[{"code":"2811025","type":"CDM"},{"code":"361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"IRRIGATION OF BLADDER-PhHOS","code_information":[{"code":"2811026","type":"CDM"},{"code":"361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT BLADDER CATHETER-PhHOS","code_information":[{"code":"2811027","type":"CDM"},{"code":"361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"facility"},{"gross_charge":40.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TEMP BLADDER CATH-PhHOS","code_information":[{"code":"2811028","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"INS BLADDER CATH COMPL-PhHOS","code_information":[{"code":"2811029","type":"CDM"},{"code":"361","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"facility"},{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE OF BLADDER TUBE-PhHOS","code_information":[{"code":"2811030","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE OF BLADDER TUBE-PhHOS","code_information":[{"code":"2811031","type":"CDM"},{"code":"361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":148.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDOSCOPIC INJ/IMPL-PhHOS","code_information":[{"code":"2811032","type":"CDM"},{"code":"361","type":"RC"},{"code":"51715","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.75,"setting":"both","billing_class":"facility"},{"gross_charge":386.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF BLADDER LES-PhHOS","code_information":[{"code":"2811033","type":"CDM"},{"code":"361","type":"RC"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF BLADDER WND-PhHOS","code_information":[{"code":"2811034","type":"CDM"},{"code":"361","type":"RC"},{"code":"51860","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.25,"setting":"both","billing_class":"facility"},{"gross_charge":1431.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY-PhHOS","code_information":[{"code":"2811035","type":"CDM"},{"code":"361","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.75,"setting":"both","billing_class":"facility"},{"gross_charge":232.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY REM OF CLOTS-PhHOS","code_information":[{"code":"2811036","type":"CDM"},{"code":"361","type":"RC"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.5,"setting":"both","billing_class":"facility"},{"gross_charge":527.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET CATHETER-PhHOS","code_information":[{"code":"2811037","type":"CDM"},{"code":"361","type":"RC"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.25,"setting":"both","billing_class":"facility"},{"gross_charge":267.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND BX-PhHOS","code_information":[{"code":"2811038","type":"CDM"},{"code":"361","type":"RC"},{"code":"52007","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY W/BIOPSY-PhHOS","code_information":[{"code":"2811039","type":"CDM"},{"code":"361","type":"RC"},{"code":"52204","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"facility"},{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY W/DESTRCT LES-PhHOS","code_information":[{"code":"2811040","type":"CDM"},{"code":"361","type":"RC"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.5,"setting":"both","billing_class":"facility"},{"gross_charge":322.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/REM LES <0.5CM-PhHO","code_information":[{"code":"2811041","type":"CDM"},{"code":"361","type":"RC"},{"code":"52224","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.5,"setting":"both","billing_class":"facility"},{"gross_charge":378.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/REM TUMOR .5-2CM-PhHOS","code_information":[{"code":"2811042","type":"CDM"},{"code":"361","type":"RC"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"setting":"both","billing_class":"facility"},{"gross_charge":452.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/REM TUMOR 2-5CM-PhHOS","code_information":[{"code":"2811043","type":"CDM"},{"code":"361","type":"RC"},{"code":"52235","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.5,"setting":"both","billing_class":"facility"},{"gross_charge":530.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/REM TUMOR >5.1CM-PhHOS","code_information":[{"code":"2811044","type":"CDM"},{"code":"361","type":"RC"},{"code":"52240","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.25,"setting":"both","billing_class":"facility"},{"gross_charge":720.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/DIL BLADDER ANES-PhHOS","code_information":[{"code":"2811045","type":"CDM"},{"code":"361","type":"RC"},{"code":"52260","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.75,"setting":"both","billing_class":"facility"},{"gross_charge":540.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY & REV URETHRA-PhHOS","code_information":[{"code":"2811046","type":"CDM"},{"code":"361","type":"RC"},{"code":"52275","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"setting":"both","billing_class":"facility"},{"gross_charge":457.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY W/URETHROTOMY-PhHOS","code_information":[{"code":"2811047","type":"CDM"},{"code":"361","type":"RC"},{"code":"52276","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.75,"setting":"both","billing_class":"facility"},{"gross_charge":490.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO DILAT URTL STRIX-PhHOS","code_information":[{"code":"2811048","type":"CDM"},{"code":"361","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.5,"setting":"both","billing_class":"facility"},{"gross_charge":280.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY CHEMODENERV-PhHOS","code_information":[{"code":"2811049","type":"CDM"},{"code":"361","type":"RC"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.5,"setting":"both","billing_class":"facility"},{"gross_charge":585.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PhHOS","code_information":[{"code":"2811050","type":"CDM"},{"code":"361","type":"RC"},{"code":"52290","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"setting":"both","billing_class":"facility"},{"gross_charge":453.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/REM STONE&STENT-PhHOS","code_information":[{"code":"2811051","type":"CDM"},{"code":"361","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.75,"setting":"both","billing_class":"facility"},{"gross_charge":283.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PhHOS","code_information":[{"code":"2811052","type":"CDM"},{"code":"361","type":"RC"},{"code":"52315","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"setting":"both","billing_class":"facility"},{"gross_charge":506.0,"setting":"both","billing_class":"professional"}]},{"description":"LITHOLAPAXY SMPL/SM<2.5CM-PhHO","code_information":[{"code":"2811053","type":"CDM"},{"code":"361","type":"RC"},{"code":"52317","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.5,"setting":"both","billing_class":"facility"},{"gross_charge":636.5,"setting":"both","billing_class":"professional"}]},{"description":"REM BLADDER STONE-PhHOS","code_information":[{"code":"2811054","type":"CDM"},{"code":"361","type":"RC"},{"code":"52318","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.25,"setting":"both","billing_class":"facility"},{"gross_charge":868.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PhHOS","code_information":[{"code":"2811055","type":"CDM"},{"code":"361","type":"RC"},{"code":"52320","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"setting":"both","billing_class":"facility"},{"gross_charge":453.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO MANJ W/O REM STONE-PhHOS","code_information":[{"code":"2811056","type":"CDM"},{"code":"361","type":"RC"},{"code":"52330","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.75,"setting":"both","billing_class":"facility"},{"gross_charge":488.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PhHOS","code_information":[{"code":"2811057","type":"CDM"},{"code":"361","type":"RC"},{"code":"52332","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.75,"setting":"both","billing_class":"facility"},{"gross_charge":285.75,"setting":"both","billing_class":"professional"}]},{"description":"CREATE PASSAGE TO KIDNEY-PhHOS","code_information":[{"code":"2811058","type":"CDM"},{"code":"361","type":"RC"},{"code":"52334","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.5,"setting":"both","billing_class":"facility"},{"gross_charge":472.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/URETER STRICT TX-PhHOS","code_information":[{"code":"2811059","type":"CDM"},{"code":"361","type":"RC"},{"code":"52341","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.5,"setting":"both","billing_class":"facility"},{"gross_charge":531.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W/UP STRICTURE TX-PhHOS","code_information":[{"code":"2811060","type":"CDM"},{"code":"361","type":"RC"},{"code":"52342","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.5,"setting":"both","billing_class":"facility"},{"gross_charge":581.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET STRICTURE TX-PhHOS","code_information":[{"code":"2811061","type":"CDM"},{"code":"361","type":"RC"},{"code":"52344","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"setting":"both","billing_class":"facility"},{"gross_charge":702.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/UP STRICT-PhHOS","code_information":[{"code":"2811062","type":"CDM"},{"code":"361","type":"RC"},{"code":"52345","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.75,"setting":"both","billing_class":"facility"},{"gross_charge":743.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOURET & OR PYELOSC-PhHOS","code_information":[{"code":"2811063","type":"CDM"},{"code":"361","type":"RC"},{"code":"52351","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.25,"setting":"both","billing_class":"facility"},{"gross_charge":568.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/STONE REM-PhHOS","code_information":[{"code":"2811064","type":"CDM"},{"code":"361","type":"RC"},{"code":"52352","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"setting":"both","billing_class":"facility"},{"gross_charge":667.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/LITHOTRIPSY-PhHOS","code_information":[{"code":"2811065","type":"CDM"},{"code":"361","type":"RC"},{"code":"52353","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.5,"setting":"both","billing_class":"facility"},{"gross_charge":735.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/BX-PhHOS","code_information":[{"code":"2811066","type":"CDM"},{"code":"361","type":"RC"},{"code":"52354","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.5,"setting":"both","billing_class":"facility"},{"gross_charge":781.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/LITHOTRIPSY-PhHOS","code_information":[{"code":"2811067","type":"CDM"},{"code":"361","type":"RC"},{"code":"52356","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"setting":"both","billing_class":"facility"},{"gross_charge":753.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/CONGEN REPR-PhHOS","code_information":[{"code":"2811068","type":"CDM"},{"code":"361","type":"RC"},{"code":"52400","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.25,"setting":"both","billing_class":"facility"},{"gross_charge":879.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/IMPLANT-PhHOS","code_information":[{"code":"2811069","type":"CDM"},{"code":"361","type":"RC"},{"code":"52441","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.5,"setting":"both","billing_class":"facility"},{"gross_charge":421.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URET W/ADDL IMPL-PhHOS","code_information":[{"code":"2811070","type":"CDM"},{"code":"361","type":"RC"},{"code":"52442","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF BLADDER NECK-PhHOS","code_information":[{"code":"2811071","type":"CDM"},{"code":"361","type":"RC"},{"code":"52500","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.75,"setting":"both","billing_class":"facility"},{"gross_charge":899.75,"setting":"both","billing_class":"professional"}]},{"description":"PROSTATECTOMY (TURP)-PhHOS","code_information":[{"code":"2811072","type":"CDM"},{"code":"361","type":"RC"},{"code":"52601","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.5,"setting":"both","billing_class":"facility"},{"gross_charge":1555.5,"setting":"both","billing_class":"professional"}]},{"description":"REM PROSTATE REGROWTH-PhHOS","code_information":[{"code":"2811073","type":"CDM"},{"code":"361","type":"RC"},{"code":"52630","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"setting":"both","billing_class":"facility"},{"gross_charge":756.0,"setting":"both","billing_class":"professional"}]},{"description":"RELIEVE BLADDER CONTRACT-PhHOS","code_information":[{"code":"2811074","type":"CDM"},{"code":"361","type":"RC"},{"code":"52640","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.5,"setting":"both","billing_class":"facility"},{"gross_charge":583.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION URETHRA-PhHOS","code_information":[{"code":"2811075","type":"CDM"},{"code":"361","type":"RC"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF URETHRA LES-PhHOS","code_information":[{"code":"2811076","type":"CDM"},{"code":"361","type":"RC"},{"code":"53265","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"setting":"both","billing_class":"facility"},{"gross_charge":349.0,"setting":"both","billing_class":"professional"}]},{"description":"DILATE URETHRA STRICTURE-PhHOS","code_information":[{"code":"2811077","type":"CDM"},{"code":"361","type":"RC"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.25,"setting":"both","billing_class":"facility"},{"gross_charge":160.25,"setting":"both","billing_class":"professional"}]},{"description":"SLITTING OF PREPUCE-PhHOS","code_information":[{"code":"2811078","type":"CDM"},{"code":"361","type":"RC"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.25,"setting":"both","billing_class":"facility"},{"gross_charge":257.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-PhHOS","code_information":[{"code":"2811079","type":"CDM"},{"code":"361","type":"RC"},{"code":"54050","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-PhHOS","code_information":[{"code":"2811080","type":"CDM"},{"code":"361","type":"RC"},{"code":"54055","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"CRYOSURG PENIS LES-PhHOS","code_information":[{"code":"2811081","type":"CDM"},{"code":"361","type":"RC"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.25,"setting":"both","billing_class":"facility"},{"gross_charge":165.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF PENIS LES-PhHOS","code_information":[{"code":"2811082","type":"CDM"},{"code":"361","type":"RC"},{"code":"54060","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"setting":"both","billing_class":"facility"},{"gross_charge":243.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-PhHOS","code_information":[{"code":"2811083","type":"CDM"},{"code":"361","type":"RC"},{"code":"54065","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"facility"},{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"CIRCUMCISION W/REGNL BLCK-PhHO","code_information":[{"code":"2811084","type":"CDM"},{"code":"361","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"CIRCUM 28 DAYS OR OLDER-PhHOS","code_information":[{"code":"2811085","type":"CDM"},{"code":"361","type":"RC"},{"code":"54161","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.25,"setting":"both","billing_class":"facility"},{"gross_charge":364.25,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS PENIL CIRCUMIC LES-PhHOS","code_information":[{"code":"2811086","type":"CDM"},{"code":"361","type":"RC"},{"code":"54162","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.25,"setting":"both","billing_class":"facility"},{"gross_charge":368.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF CIRCUMCISION-PhHOS","code_information":[{"code":"2811087","type":"CDM"},{"code":"361","type":"RC"},{"code":"54163","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"setting":"both","billing_class":"facility"},{"gross_charge":405.0,"setting":"both","billing_class":"professional"}]},{"description":"INS MULTI-COMP PENIS PR-PhHOS","code_information":[{"code":"2811088","type":"CDM"},{"code":"361","type":"RC"},{"code":"54405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.5,"setting":"both","billing_class":"facility"},{"gross_charge":1493.5,"setting":"both","billing_class":"professional"}]},{"description":"REM MUTI-COMP PENIS PROS-PhHOS","code_information":[{"code":"2811089","type":"CDM"},{"code":"361","type":"RC"},{"code":"54406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.5,"setting":"both","billing_class":"facility"},{"gross_charge":1349.5,"setting":"both","billing_class":"professional"}]},{"description":"REM/REPLACE PENIS PROSTH-PhHOS","code_information":[{"code":"2811090","type":"CDM"},{"code":"361","type":"RC"},{"code":"54410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"setting":"both","billing_class":"facility"},{"gross_charge":1577.0,"setting":"both","billing_class":"professional"}]},{"description":"PREPUTIAL STRETCHING-PhHOS","code_information":[{"code":"2811091","type":"CDM"},{"code":"361","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF TESTIS-PhHOS","code_information":[{"code":"2811092","type":"CDM"},{"code":"361","type":"RC"},{"code":"54505","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.75,"setting":"both","billing_class":"facility"},{"gross_charge":386.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TESTIS-PhHOS","code_information":[{"code":"2811093","type":"CDM"},{"code":"361","type":"RC"},{"code":"54520","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"setting":"both","billing_class":"facility"},{"gross_charge":605.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF TESTIS-PhHOS","code_information":[{"code":"2811094","type":"CDM"},{"code":"361","type":"RC"},{"code":"54530","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.5,"setting":"both","billing_class":"facility"},{"gross_charge":935.5,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORATION FOR TESTIS-PhHOS","code_information":[{"code":"2811095","type":"CDM"},{"code":"361","type":"RC"},{"code":"54550","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"REDUCE TESTIS TORSION-PhHOS","code_information":[{"code":"2811096","type":"CDM"},{"code":"361","type":"RC"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.75,"setting":"both","billing_class":"facility"},{"gross_charge":845.75,"setting":"both","billing_class":"professional"}]},{"description":"ORCHIOPEXY EITHER APPR-PhHOS","code_information":[{"code":"2811097","type":"CDM"},{"code":"360","type":"RC"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.5,"setting":"both","billing_class":"facility"},{"gross_charge":892.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN SCROTUM-PhHOS","code_information":[{"code":"2811098","type":"CDM"},{"code":"361","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"setting":"both","billing_class":"facility"},{"gross_charge":398.0,"setting":"both","billing_class":"professional"}]},{"description":"REM EPIDIDYMIS LES-PhHOS","code_information":[{"code":"2811099","type":"CDM"},{"code":"361","type":"RC"},{"code":"54830","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.5,"setting":"both","billing_class":"facility"},{"gross_charge":682.5,"setting":"both","billing_class":"professional"}]},{"description":"REM EPIDIDYMIS LES-PhHOS","code_information":[{"code":"2811100","type":"CDM"},{"code":"361","type":"RC"},{"code":"54840","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.75,"setting":"both","billing_class":"facility"},{"gross_charge":593.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF EPIDIDYMIS UNI-PhHOS","code_information":[{"code":"2811101","type":"CDM"},{"code":"361","type":"RC"},{"code":"54860","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.25,"setting":"both","billing_class":"facility"},{"gross_charge":773.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF EPIDIDYMIS BIL-PhHOS","code_information":[{"code":"2811102","type":"CDM"},{"code":"361","type":"RC"},{"code":"54861","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.5,"setting":"both","billing_class":"facility"},{"gross_charge":1045.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF HYDROCELE UNI-PhHOS","code_information":[{"code":"2811103","type":"CDM"},{"code":"361","type":"RC"},{"code":"55040","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.5,"setting":"both","billing_class":"facility"},{"gross_charge":629.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF HYDROCELE BIL-PhHOS","code_information":[{"code":"2811104","type":"CDM"},{"code":"361","type":"RC"},{"code":"55041","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.75,"setting":"both","billing_class":"facility"},{"gross_charge":944.75,"setting":"both","billing_class":"professional"}]},{"description":"REP OF HYDROCELE-PhHOS","code_information":[{"code":"2811105","type":"CDM"},{"code":"361","type":"RC"},{"code":"55060","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"setting":"both","billing_class":"facility"},{"gross_charge":703.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN SCROTUM ABSCESS-PhHOS","code_information":[{"code":"2811106","type":"CDM"},{"code":"361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.25,"setting":"both","billing_class":"facility"},{"gross_charge":312.25,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE SCROTUM-PhHOS","code_information":[{"code":"2811107","type":"CDM"},{"code":"361","type":"RC"},{"code":"55110","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"setting":"both","billing_class":"facility"},{"gross_charge":713.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPERM DUCT-PhHOS","code_information":[{"code":"2811108","type":"CDM"},{"code":"361","type":"RC"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"facility"},{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPERM CORD LES-PhHOS","code_information":[{"code":"2811109","type":"CDM"},{"code":"361","type":"RC"},{"code":"55520","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"setting":"both","billing_class":"facility"},{"gross_charge":859.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF PROSTATE-PhHOS","code_information":[{"code":"2811110","type":"CDM"},{"code":"361","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"setting":"both","billing_class":"facility"},{"gross_charge":248.0,"setting":"both","billing_class":"professional"}]},{"description":"EXT PROSTATE SURG-PhHOS","code_information":[{"code":"2811111","type":"CDM"},{"code":"361","type":"RC"},{"code":"55815","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.25,"setting":"both","billing_class":"facility"},{"gross_charge":3265.25,"setting":"both","billing_class":"professional"}]},{"description":"I & D OF VULVA/PERINEUM-PhHOS","code_information":[{"code":"2811112","type":"CDM"},{"code":"361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.25,"setting":"both","billing_class":"facility"},{"gross_charge":209.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN GLAND ABSCESS-PhHOS","code_information":[{"code":"2811113","type":"CDM"},{"code":"361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS OF LABIAL LES-PhHOS","code_information":[{"code":"2811114","type":"CDM"},{"code":"361","type":"RC"},{"code":"56441","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.25,"setting":"both","billing_class":"facility"},{"gross_charge":262.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST VULVA LESS SIM-PhHOS","code_information":[{"code":"2811115","type":"CDM"},{"code":"361","type":"RC"},{"code":"56501","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"setting":"both","billing_class":"facility"},{"gross_charge":171.5,"setting":"both","billing_class":"professional"}]},{"description":"DEST VULVA LES/S COMPL-PhHOS","code_information":[{"code":"2811116","type":"CDM"},{"code":"361","type":"RC"},{"code":"56515","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.5,"setting":"both","billing_class":"facility"},{"gross_charge":379.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-PhHOS","code_information":[{"code":"2811117","type":"CDM"},{"code":"361","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-PhHOS","code_information":[{"code":"2811118","type":"CDM"},{"code":"361","type":"RC"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"facility"},{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF VULVA-PhHOS","code_information":[{"code":"2811119","type":"CDM"},{"code":"361","type":"RC"},{"code":"56620","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.25,"setting":"both","billing_class":"facility"},{"gross_charge":971.25,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINA GLAND LES-PhHOS","code_information":[{"code":"2811120","type":"CDM"},{"code":"361","type":"RC"},{"code":"56740","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.25,"setting":"both","billing_class":"facility"},{"gross_charge":568.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF VAGINA-PhHOS","code_information":[{"code":"2811121","type":"CDM"},{"code":"361","type":"RC"},{"code":"56800","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"setting":"both","billing_class":"facility"},{"gross_charge":457.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF PERINEUM-PhHOS","code_information":[{"code":"2811122","type":"CDM"},{"code":"361","type":"RC"},{"code":"56810","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.75,"setting":"both","billing_class":"facility"},{"gross_charge":493.75,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF VULVA W/SCOPE-PhHOS","code_information":[{"code":"2811123","type":"CDM"},{"code":"361","type":"RC"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"facility"},{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"EXAM/BX OF VULVA W/SCOPE-PhHOS","code_information":[{"code":"2811124","type":"CDM"},{"code":"361","type":"RC"},{"code":"56821","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.5,"setting":"both","billing_class":"facility"},{"gross_charge":217.5,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORATION OF VAGINA-PhHOS","code_information":[{"code":"2811125","type":"CDM"},{"code":"361","type":"RC"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"facility"},{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"I&D VAG HEMATOMA NON-OB-PhHOS","code_information":[{"code":"2811126","type":"CDM"},{"code":"361","type":"RC"},{"code":"57023","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.75,"setting":"both","billing_class":"facility"},{"gross_charge":592.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST VAG LESS SIMPLE-PhHOS","code_information":[{"code":"2811127","type":"CDM"},{"code":"361","type":"RC"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST VAG LESS COMPLEX-PhHOS","code_information":[{"code":"2811128","type":"CDM"},{"code":"361","type":"RC"},{"code":"57065","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"facility"},{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VAGINA-PhHOS","code_information":[{"code":"2811129","type":"CDM"},{"code":"361","type":"RC"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"facility"},{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE OF VAGINA-PhHOS","code_information":[{"code":"2811130","type":"CDM"},{"code":"361","type":"RC"},{"code":"57120","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.25,"setting":"both","billing_class":"facility"},{"gross_charge":973.25,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINA LES-PhHOS","code_information":[{"code":"2811131","type":"CDM"},{"code":"361","type":"RC"},{"code":"57135","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.5,"setting":"both","billing_class":"facility"},{"gross_charge":328.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT UTERI TAND/OVOIDS-PhHOS","code_information":[{"code":"2811132","type":"CDM"},{"code":"361","type":"RC"},{"code":"57155","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.5,"setting":"both","billing_class":"facility"},{"gross_charge":527.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT PESSARY/OTH DEV-PhHOS","code_information":[{"code":"2811133","type":"CDM"},{"code":"361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"REP OF VAGINA-PhHOS","code_information":[{"code":"2811134","type":"CDM"},{"code":"361","type":"RC"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.25,"setting":"both","billing_class":"facility"},{"gross_charge":571.25,"setting":"both","billing_class":"professional"}]},{"description":"REP BLADDER & VAGINA-PhHOS","code_information":[{"code":"2811135","type":"CDM"},{"code":"361","type":"RC"},{"code":"57240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.75,"setting":"both","billing_class":"facility"},{"gross_charge":1259.75,"setting":"both","billing_class":"professional"}]},{"description":"REP RECTUM & VAGINA-PhHOS","code_information":[{"code":"2811136","type":"CDM"},{"code":"361","type":"RC"},{"code":"57250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.25,"setting":"both","billing_class":"facility"},{"gross_charge":1286.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF VAGINA-PhHOS","code_information":[{"code":"2811137","type":"CDM"},{"code":"361","type":"RC"},{"code":"57260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.25,"setting":"both","billing_class":"facility"},{"gross_charge":1582.25,"setting":"both","billing_class":"professional"}]},{"description":"EXT REP OF VAGINA-PhHOS","code_information":[{"code":"2811138","type":"CDM"},{"code":"361","type":"RC"},{"code":"57265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1732.0,"setting":"both","billing_class":"facility"},{"gross_charge":1732.0,"setting":"both","billing_class":"professional"}]},{"description":"INS MESH/PELV FLR ADDON-PhHOS","code_information":[{"code":"2811139","type":"CDM"},{"code":"361","type":"RC"},{"code":"57267","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.5,"setting":"both","billing_class":"facility"},{"gross_charge":482.5,"setting":"both","billing_class":"professional"}]},{"description":"REP OF BOWEL BULGE-PhHOS","code_information":[{"code":"2811140","type":"CDM"},{"code":"361","type":"RC"},{"code":"57268","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.5,"setting":"both","billing_class":"facility"},{"gross_charge":881.5,"setting":"both","billing_class":"professional"}]},{"description":"SUSPENSION OF VAGINA-PhHOS","code_information":[{"code":"2811141","type":"CDM"},{"code":"361","type":"RC"},{"code":"57280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.5,"setting":"both","billing_class":"facility"},{"gross_charge":1804.5,"setting":"both","billing_class":"professional"}]},{"description":"COLPOPEXY EXRAPERITONEAL-PhHOS","code_information":[{"code":"2811142","type":"CDM"},{"code":"361","type":"RC"},{"code":"57282","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.75,"setting":"both","billing_class":"facility"},{"gross_charge":950.75,"setting":"both","billing_class":"professional"}]},{"description":"COLPOPEXY INTRAPERIT-PhHOS","code_information":[{"code":"2811143","type":"CDM"},{"code":"361","type":"RC"},{"code":"57283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.75,"setting":"both","billing_class":"facility"},{"gross_charge":1303.75,"setting":"both","billing_class":"professional"}]},{"description":"REV/REM SLING REP-PhHOS","code_information":[{"code":"2811144","type":"CDM"},{"code":"361","type":"RC"},{"code":"57287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1717.75,"setting":"both","billing_class":"facility"},{"gross_charge":1717.75,"setting":"both","billing_class":"professional"}]},{"description":"REP BLADDER DEFECT-PhHOS","code_information":[{"code":"2811145","type":"CDM"},{"code":"361","type":"RC"},{"code":"57288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.5,"setting":"both","billing_class":"facility"},{"gross_charge":1803.5,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE VAGINAL GRFT-PhHOS","code_information":[{"code":"2811146","type":"CDM"},{"code":"361","type":"RC"},{"code":"57295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1198.5,"setting":"both","billing_class":"facility"},{"gross_charge":1198.5,"setting":"both","billing_class":"professional"}]},{"description":"REP RECTUM-VAGINA FIST-PhHOS","code_information":[{"code":"2811147","type":"CDM"},{"code":"361","type":"RC"},{"code":"57300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.75,"setting":"both","billing_class":"facility"},{"gross_charge":1050.75,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINAL FB-PhHOS","code_information":[{"code":"2811148","type":"CDM"},{"code":"361","type":"RC"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF VAGINA W/SCOPE-PhHOS","code_information":[{"code":"2811149","type":"CDM"},{"code":"361","type":"RC"},{"code":"57420","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"setting":"both","billing_class":"facility"},{"gross_charge":171.5,"setting":"both","billing_class":"professional"}]},{"description":"EXAM/BX OF VAG W/SCOPE-PhHOS","code_information":[{"code":"2811150","type":"CDM"},{"code":"361","type":"RC"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.75,"setting":"both","billing_class":"facility"},{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC SURG COLPOPEXY-PhHOS","code_information":[{"code":"2811151","type":"CDM"},{"code":"361","type":"RC"},{"code":"57425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.25,"setting":"both","billing_class":"facility"},{"gross_charge":1838.25,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF CERVIX W/SCOPE-PhHOS","code_information":[{"code":"2811152","type":"CDM"},{"code":"361","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.75,"setting":"both","billing_class":"facility"},{"gross_charge":136.75,"setting":"both","billing_class":"professional"}]},{"description":"BX/CURETT OF CERVIX W/SC-PhHOS","code_information":[{"code":"2811153","type":"CDM"},{"code":"361","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX W/SCOPE-PhHOS","code_information":[{"code":"2811154","type":"CDM"},{"code":"361","type":"RC"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"facility"},{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"BX CERVIX W/SCOPE LEEP-PhHOS","code_information":[{"code":"2811155","type":"CDM"},{"code":"361","type":"RC"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"facility"},{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX-PhHOS","code_information":[{"code":"2811156","type":"CDM"},{"code":"361","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOCERVICAL CURETTAGE-PhHOS","code_information":[{"code":"2811157","type":"CDM"},{"code":"361","type":"RC"},{"code":"57505","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.75,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","billing_class":"professional"}]},{"description":"CAUTERIZATION OF CERVIX-PhHOS","code_information":[{"code":"2811158","type":"CDM"},{"code":"361","type":"RC"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"},{"gross_charge":220.5,"setting":"both","billing_class":"professional"}]},{"description":"CONIZATION OF CERVIX-PhHOS","code_information":[{"code":"2811159","type":"CDM"},{"code":"361","type":"RC"},{"code":"57520","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.25,"setting":"both","billing_class":"facility"},{"gross_charge":521.25,"setting":"both","billing_class":"professional"}]},{"description":"CONIZATION OF CERVIX-PhHOS","code_information":[{"code":"2811160","type":"CDM"},{"code":"361","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.25,"setting":"both","billing_class":"facility"},{"gross_charge":466.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF CERVIX-PhHOS","code_information":[{"code":"2811161","type":"CDM"},{"code":"361","type":"RC"},{"code":"57530","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF UTERUS LINING-PhHOS","code_information":[{"code":"2811162","type":"CDM"},{"code":"361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.75,"setting":"both","billing_class":"facility"},{"gross_charge":130.75,"setting":"both","billing_class":"professional"}]},{"description":"DILATION AND CURETTAGE-PhHOS","code_information":[{"code":"2811163","type":"CDM"},{"code":"361","type":"RC"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","billing_class":"facility"},{"gross_charge":416.25,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL HYSTER-PhHOS","code_information":[{"code":"2811164","type":"CDM"},{"code":"361","type":"RC"},{"code":"58150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1903.5,"setting":"both","billing_class":"facility"},{"gross_charge":1903.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL HYSTER-PhHOS","code_information":[{"code":"2811165","type":"CDM"},{"code":"361","type":"RC"},{"code":"58180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.0,"setting":"both","billing_class":"facility"},{"gross_charge":1824.0,"setting":"both","billing_class":"professional"}]},{"description":"EXENSIVE HYSTER-PhHOS","code_information":[{"code":"2811166","type":"CDM"},{"code":"361","type":"RC"},{"code":"58200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.5,"setting":"both","billing_class":"facility"},{"gross_charge":2515.5,"setting":"both","billing_class":"professional"}]},{"description":"EXENSIVE HYSTER-PhHOS","code_information":[{"code":"2811167","type":"CDM"},{"code":"361","type":"RC"},{"code":"58210","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.25,"setting":"both","billing_class":"facility"},{"gross_charge":3371.25,"setting":"both","billing_class":"professional"}]},{"description":"VAGINAL HYSTER-PhHOS","code_information":[{"code":"2811168","type":"CDM"},{"code":"361","type":"RC"},{"code":"58260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"setting":"both","billing_class":"facility"},{"gross_charge":1576.0,"setting":"both","billing_class":"professional"}]},{"description":"VAG HYST INCLUDING T/O-PhHOS","code_information":[{"code":"2811169","type":"CDM"},{"code":"361","type":"RC"},{"code":"58262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.5,"setting":"both","billing_class":"facility"},{"gross_charge":1756.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT INTRAUTERINE DEV-PhHOS","code_information":[{"code":"2811170","type":"CDM"},{"code":"361","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.5,"setting":"both","billing_class":"professional"}]},{"description":"REM INTRAUTERINE DEV-PhHOS","code_information":[{"code":"2811171","type":"CDM"},{"code":"361","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.75,"setting":"both","billing_class":"facility"},{"gross_charge":128.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTIFICIAL INSEMINATION-PhHOS","code_information":[{"code":"2811172","type":"CDM"},{"code":"361","type":"RC"},{"code":"58322","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"REOPEN FALLOPIAN TUBE-PhHOS","code_information":[{"code":"2811173","type":"CDM"},{"code":"361","type":"RC"},{"code":"58350","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"SUPRACER HYSTERECT <250G-PhHOS","code_information":[{"code":"2811174","type":"CDM"},{"code":"361","type":"RC"},{"code":"58541","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.5,"setting":"both","billing_class":"facility"},{"gross_charge":1647.5,"setting":"both","billing_class":"professional"}]},{"description":"SUPRAC HYSTER TUB/OV REM-PhHOS","code_information":[{"code":"2811175","type":"CDM"},{"code":"361","type":"RC"},{"code":"58542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.25,"setting":"both","billing_class":"facility"},{"gross_charge":1840.25,"setting":"both","billing_class":"professional"}]},{"description":"SUPRACERV HYSTERECT>250G-PhHOS","code_information":[{"code":"2811176","type":"CDM"},{"code":"361","type":"RC"},{"code":"58543","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.75,"setting":"both","billing_class":"facility"},{"gross_charge":1869.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPIC MYOMECTOMY-PhHOS","code_information":[{"code":"2811177","type":"CDM"},{"code":"361","type":"RC"},{"code":"58545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1705.5,"setting":"both","billing_class":"facility"},{"gross_charge":1705.5,"setting":"both","billing_class":"professional"}]},{"description":"LAP-ASST VAG HYSTERECT-PhHOS","code_information":[{"code":"2811178","type":"CDM"},{"code":"361","type":"RC"},{"code":"58550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.0,"setting":"both","billing_class":"facility"},{"gross_charge":1682.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-VAG HYST INCL T/O-PhHOS","code_information":[{"code":"2811179","type":"CDM"},{"code":"361","type":"RC"},{"code":"58552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.75,"setting":"both","billing_class":"facility"},{"gross_charge":1869.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-VAG HYST COMPLEX-PhHOS","code_information":[{"code":"2811180","type":"CDM"},{"code":"361","type":"RC"},{"code":"58553","type":"HCPCS"}],"standard_charges":[{"gross_charge":2161.5,"setting":"both","billing_class":"facility"},{"gross_charge":2161.5,"setting":"both","billing_class":"professional"}]},{"description":"LAP-VAG HYST W/T/O COMP-PhHOS","code_information":[{"code":"2811181","type":"CDM"},{"code":"361","type":"RC"},{"code":"58554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2506.25,"setting":"both","billing_class":"facility"},{"gross_charge":2506.25,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC DX SEP PROC-PhHOS","code_information":[{"code":"2811182","type":"CDM"},{"code":"361","type":"RC"},{"code":"58555","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"facility"},{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC BX-PhHOS","code_information":[{"code":"2811183","type":"CDM"},{"code":"361","type":"RC"},{"code":"58558","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"setting":"both","billing_class":"facility"},{"gross_charge":508.0,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC RESECT SEPTUM-PhHOS","code_information":[{"code":"2811184","type":"CDM"},{"code":"361","type":"RC"},{"code":"58560","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.5,"setting":"both","billing_class":"facility"},{"gross_charge":735.5,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC REM MYOMA-PhHOS","code_information":[{"code":"2811185","type":"CDM"},{"code":"361","type":"RC"},{"code":"58561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.5,"setting":"both","billing_class":"facility"},{"gross_charge":1040.5,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC REM FB-PhHOS","code_information":[{"code":"2811186","type":"CDM"},{"code":"361","type":"RC"},{"code":"58562","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"setting":"both","billing_class":"facility"},{"gross_charge":552.0,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC ABLATION-PhHOS","code_information":[{"code":"2811187","type":"CDM"},{"code":"361","type":"RC"},{"code":"58563","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"setting":"both","billing_class":"facility"},{"gross_charge":652.0,"setting":"both","billing_class":"professional"}]},{"description":"HYSTEROSC STERILIZATION-PhHOS","code_information":[{"code":"2811188","type":"CDM"},{"code":"361","type":"RC"},{"code":"58565","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.5,"setting":"both","billing_class":"facility"},{"gross_charge":829.5,"setting":"both","billing_class":"professional"}]},{"description":"LAP SURG W/TOTAL HYSTER-PhHOS","code_information":[{"code":"2811189","type":"CDM"},{"code":"361","type":"RC"},{"code":"58570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.75,"setting":"both","billing_class":"facility"},{"gross_charge":1771.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROS TOTAL HYSTER-PhHOS","code_information":[{"code":"2811190","type":"CDM"},{"code":"361","type":"RC"},{"code":"58571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.0,"setting":"both","billing_class":"facility"},{"gross_charge":1977.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROS TOTAL HYSTER-PhHOS","code_information":[{"code":"2811191","type":"CDM"},{"code":"361","type":"RC"},{"code":"58572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2203.25,"setting":"both","billing_class":"facility"},{"gross_charge":2203.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP TOTAL HYSTERECT-PhHOS","code_information":[{"code":"2811192","type":"CDM"},{"code":"361","type":"RC"},{"code":"58573","type":"HCPCS"}],"standard_charges":[{"gross_charge":2203.25,"setting":"both","billing_class":"facility"},{"gross_charge":2203.25,"setting":"both","billing_class":"professional"}]},{"description":"DIVISION FALLOPIAN TUBE-PhHOS","code_information":[{"code":"2811193","type":"CDM"},{"code":"361","type":"RC"},{"code":"58605","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.5,"setting":"both","billing_class":"facility"},{"gross_charge":628.5,"setting":"both","billing_class":"professional"}]},{"description":"LIGATE OVIDUCT ADD-ON-PhHOS","code_information":[{"code":"2811194","type":"CDM"},{"code":"361","type":"RC"},{"code":"58611","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"OCCLUDE FALLOPIAN TUBE-PhHOS","code_information":[{"code":"2811195","type":"CDM"},{"code":"361","type":"RC"},{"code":"58615","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.25,"setting":"both","billing_class":"facility"},{"gross_charge":466.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC LYSIS-PhHOS","code_information":[{"code":"2811196","type":"CDM"},{"code":"361","type":"RC"},{"code":"58660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.75,"setting":"both","billing_class":"facility"},{"gross_charge":1505.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC REM ADNEXA-PhHOS","code_information":[{"code":"2811197","type":"CDM"},{"code":"361","type":"RC"},{"code":"58661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"setting":"both","billing_class":"facility"},{"gross_charge":1266.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC EXISE LESS-PhHOS","code_information":[{"code":"2811198","type":"CDM"},{"code":"361","type":"RC"},{"code":"58662","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.5,"setting":"both","billing_class":"facility"},{"gross_charge":1343.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC TUBAL CAUTERY-PhHOS","code_information":[{"code":"2811199","type":"CDM"},{"code":"361","type":"RC"},{"code":"58670","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.75,"setting":"both","billing_class":"facility"},{"gross_charge":697.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC TUBAL BL-PhHOS","code_information":[{"code":"2811200","type":"CDM"},{"code":"361","type":"RC"},{"code":"58671","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.75,"setting":"both","billing_class":"facility"},{"gross_charge":697.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FALLOPIAN TUBE-PhHOS","code_information":[{"code":"2811201","type":"CDM"},{"code":"361","type":"RC"},{"code":"58700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.0,"setting":"both","billing_class":"facility"},{"gross_charge":1423.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF OVARY/TUBE-PhHOS","code_information":[{"code":"2811202","type":"CDM"},{"code":"361","type":"RC"},{"code":"58720","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.25,"setting":"both","billing_class":"facility"},{"gross_charge":1381.25,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS FALLOPIAN TUBE-PhHOS","code_information":[{"code":"2811203","type":"CDM"},{"code":"361","type":"RC"},{"code":"58740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"setting":"both","billing_class":"facility"},{"gross_charge":1673.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN OVARIAN CYST-PhHOS","code_information":[{"code":"2811204","type":"CDM"},{"code":"361","type":"RC"},{"code":"58800","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.25,"setting":"both","billing_class":"facility"},{"gross_charge":570.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN OVARIAN CYST-PhHOS","code_information":[{"code":"2811205","type":"CDM"},{"code":"361","type":"RC"},{"code":"58805","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.25,"setting":"both","billing_class":"facility"},{"gross_charge":770.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF OVARIAN CYST-PhHOS","code_information":[{"code":"2811206","type":"CDM"},{"code":"361","type":"RC"},{"code":"58925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.75,"setting":"both","billing_class":"facility"},{"gross_charge":1411.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF OVARY-PhHOS","code_information":[{"code":"2811207","type":"CDM"},{"code":"361","type":"RC"},{"code":"58940","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.5,"setting":"both","billing_class":"facility"},{"gross_charge":992.5,"setting":"both","billing_class":"professional"}]},{"description":"BSO OMENTECTOMY W/TAH-PhHOS","code_information":[{"code":"2811208","type":"CDM"},{"code":"361","type":"RC"},{"code":"58956","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.75,"setting":"both","billing_class":"facility"},{"gross_charge":2536.75,"setting":"both","billing_class":"professional"}]},{"description":"FETAL NST TEST PRO READ-PhHOS","code_information":[{"code":"2811209","type":"CDM"},{"code":"361","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"facility"},{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"TX ECTOPIC PREGNANCY-PhHOS","code_information":[{"code":"2811210","type":"CDM"},{"code":"361","type":"RC"},{"code":"59150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1478.0,"setting":"both","billing_class":"facility"},{"gross_charge":1478.0,"setting":"both","billing_class":"professional"}]},{"description":"TX ECTOPIC PREGNANCY-PhHOS","code_information":[{"code":"2811211","type":"CDM"},{"code":"361","type":"RC"},{"code":"59151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.25,"setting":"both","billing_class":"facility"},{"gross_charge":1436.25,"setting":"both","billing_class":"professional"}]},{"description":"D & C AFTER DELIVERY-PhHOS","code_information":[{"code":"2811212","type":"CDM"},{"code":"361","type":"RC"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.5,"setting":"both","billing_class":"facility"},{"gross_charge":331.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT CERVICAL DILATOR-PhHOS","code_information":[{"code":"2811213","type":"CDM"},{"code":"361","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"},{"gross_charge":86.75,"setting":"both","billing_class":"professional"}]},{"description":"REVION OF CERVIX-PhHOS","code_information":[{"code":"2811214","type":"CDM"},{"code":"361","type":"RC"},{"code":"59320","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.75,"setting":"both","billing_class":"facility"},{"gross_charge":292.75,"setting":"both","billing_class":"professional"}]},{"description":"REP OF UTERUS-PhHOS","code_information":[{"code":"2811215","type":"CDM"},{"code":"361","type":"RC"},{"code":"59350","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.75,"setting":"both","billing_class":"facility"},{"gross_charge":538.75,"setting":"both","billing_class":"professional"}]},{"description":"OBSTETRICAL CARE-PhHOS","code_information":[{"code":"2811216","type":"CDM"},{"code":"361","type":"RC"},{"code":"59400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4023.0,"setting":"both","billing_class":"facility"},{"gross_charge":4023.0,"setting":"both","billing_class":"professional"}]},{"description":"VAGINAL DELIVERY-PhHOS","code_information":[{"code":"2811217","type":"CDM"},{"code":"361","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":1935.0,"setting":"both","billing_class":"facility"},{"gross_charge":1935.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTEPARTUM MANIPULATION-PhHOS","code_information":[{"code":"2811218","type":"CDM"},{"code":"361","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"DELIVER PLACENTA-PhHOS","code_information":[{"code":"2811219","type":"CDM"},{"code":"361","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"setting":"both","billing_class":"facility"},{"gross_charge":175.5,"setting":"both","billing_class":"professional"}]},{"description":"ANTEPARTUM CARE ONLY-PhHOS","code_information":[{"code":"2811220","type":"CDM"},{"code":"361","type":"RC"},{"code":"59425","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.25,"setting":"both","billing_class":"facility"},{"gross_charge":774.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTEPARTUM CARE ONLY-PhHOS","code_information":[{"code":"2811221","type":"CDM"},{"code":"361","type":"RC"},{"code":"59426","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.25,"setting":"both","billing_class":"facility"},{"gross_charge":1381.25,"setting":"both","billing_class":"professional"}]},{"description":"CARE AFTER DELIVERY-PhHOS","code_information":[{"code":"2811222","type":"CDM"},{"code":"361","type":"RC"},{"code":"59430","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"CESAREAN DELIVERY-PhHOS","code_information":[{"code":"2811223","type":"CDM"},{"code":"361","type":"RC"},{"code":"59510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4446.25,"setting":"both","billing_class":"facility"},{"gross_charge":4446.25,"setting":"both","billing_class":"professional"}]},{"description":"CESAREAN DELIVERY ONLY-PhHOS","code_information":[{"code":"2811224","type":"CDM"},{"code":"361","type":"RC"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.25,"setting":"both","billing_class":"facility"},{"gross_charge":2093.25,"setting":"both","billing_class":"professional"}]},{"description":"TX OF MISCARRIAGE-PhHOS","code_information":[{"code":"2811225","type":"CDM"},{"code":"361","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.5,"setting":"both","billing_class":"facility"},{"gross_charge":585.5,"setting":"both","billing_class":"professional"}]},{"description":"CARE OF MISCARRIAGE-PhHOS","code_information":[{"code":"2811226","type":"CDM"},{"code":"361","type":"RC"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.5,"setting":"both","billing_class":"facility"},{"gross_charge":687.5,"setting":"both","billing_class":"professional"}]},{"description":"TX OF MISCARRIAGE-PhHOS","code_information":[{"code":"2811227","type":"CDM"},{"code":"361","type":"RC"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.5,"setting":"both","billing_class":"facility"},{"gross_charge":687.5,"setting":"both","billing_class":"professional"}]},{"description":"REM THYROID LES-PhHOS","code_information":[{"code":"2811228","type":"CDM"},{"code":"361","type":"RC"},{"code":"60200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.75,"setting":"both","billing_class":"facility"},{"gross_charge":1255.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL THYROID EXISION-PhHOS","code_information":[{"code":"2811229","type":"CDM"},{"code":"361","type":"RC"},{"code":"60210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.75,"setting":"both","billing_class":"facility"},{"gross_charge":1308.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL THYROID EXISION-PhHOS","code_information":[{"code":"2811230","type":"CDM"},{"code":"361","type":"RC"},{"code":"60212","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.75,"setting":"both","billing_class":"facility"},{"gross_charge":1862.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF THYROID-PhHOS","code_information":[{"code":"2811231","type":"CDM"},{"code":"361","type":"RC"},{"code":"60220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.5,"setting":"both","billing_class":"facility"},{"gross_charge":1343.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF THYROID-PhHOS","code_information":[{"code":"2811232","type":"CDM"},{"code":"361","type":"RC"},{"code":"60225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.75,"setting":"both","billing_class":"facility"},{"gross_charge":1766.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THYROID-PhHOS","code_information":[{"code":"2811233","type":"CDM"},{"code":"361","type":"RC"},{"code":"60240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.25,"setting":"both","billing_class":"facility"},{"gross_charge":1738.25,"setting":"both","billing_class":"professional"}]},{"description":"REPEAT THYROID SURG-PhHOS","code_information":[{"code":"2811234","type":"CDM"},{"code":"361","type":"RC"},{"code":"60260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.5,"setting":"both","billing_class":"facility"},{"gross_charge":2059.5,"setting":"both","billing_class":"professional"}]},{"description":"REM THYROID DUCT LES-PhHOS","code_information":[{"code":"2811235","type":"CDM"},{"code":"361","type":"RC"},{"code":"60280","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.25,"setting":"both","billing_class":"facility"},{"gross_charge":819.25,"setting":"both","billing_class":"professional"}]},{"description":"REM THYROID DUCT LES-PhHOS","code_information":[{"code":"2811236","type":"CDM"},{"code":"361","type":"RC"},{"code":"60281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.75,"setting":"both","billing_class":"facility"},{"gross_charge":1105.75,"setting":"both","billing_class":"professional"}]},{"description":"EXPL PARATHYROID GLAND-PhHOS","code_information":[{"code":"2811237","type":"CDM"},{"code":"361","type":"RC"},{"code":"60500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.0,"setting":"both","billing_class":"facility"},{"gross_charge":1826.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SKULL LES-PhHOS","code_information":[{"code":"2811238","type":"CDM"},{"code":"361","type":"RC"},{"code":"61500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3594.5,"setting":"both","billing_class":"facility"},{"gross_charge":3594.5,"setting":"both","billing_class":"professional"}]},{"description":"SCAN PROC CRANIAL EXRA-PhHOS","code_information":[{"code":"2811239","type":"CDM"},{"code":"361","type":"RC"},{"code":"61782","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.25,"setting":"both","billing_class":"facility"},{"gross_charge":359.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL FLUID TAP DX-PhHOS","code_information":[{"code":"2811240","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":148.0,"setting":"both","billing_class":"professional"}]},{"description":"N BL INJ OCCIPITAL-PhHOS","code_information":[{"code":"2811241","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"},{"gross_charge":179.75,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK OTHER PERIPHERAL-PhHOS","code_information":[{"code":"2811242","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"facility"},{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"N BL INJ PLANTAR DIGIT-PhHOS","code_information":[{"code":"2811243","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"facility"},{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ TX OF NERVE-PhHOS","code_information":[{"code":"2811244","type":"CDM"},{"code":"361","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"facility"},{"gross_charge":412.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST NERVE FC MSCL-PhHOS","code_information":[{"code":"2811245","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"REV ULNAR NERVE AT ELBOW-PhHOS","code_information":[{"code":"2811246","type":"CDM"},{"code":"361","type":"RC"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.25,"setting":"both","billing_class":"facility"},{"gross_charge":1128.25,"setting":"both","billing_class":"professional"}]},{"description":"REV ULNAR NERVE AT WRIST-PhHOS","code_information":[{"code":"2811247","type":"CDM"},{"code":"361","type":"RC"},{"code":"64719","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.5,"setting":"both","billing_class":"facility"},{"gross_charge":739.5,"setting":"both","billing_class":"professional"}]},{"description":"CARPAL TUNNEL SURG-PhHOS","code_information":[{"code":"2811248","type":"CDM"},{"code":"361","type":"RC"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"setting":"both","billing_class":"facility"},{"gross_charge":811.0,"setting":"both","billing_class":"professional"}]},{"description":"REM DIGIT NERVE LES-PhHOS","code_information":[{"code":"2811249","type":"CDM"},{"code":"361","type":"RC"},{"code":"64776","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.5,"setting":"both","billing_class":"facility"},{"gross_charge":733.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF NERVE-PhHOS","code_information":[{"code":"2811250","type":"CDM"},{"code":"361","type":"RC"},{"code":"64795","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.25,"setting":"both","billing_class":"facility"},{"gross_charge":367.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FB FROM EYE-PhHOS","code_information":[{"code":"2811251","type":"CDM"},{"code":"361","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"facility"},{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FB FROM EYE-PhHOS","code_information":[{"code":"2811252","type":"CDM"},{"code":"361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"facility"},{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FB FROM EYE-PhHOS","code_information":[{"code":"2811253","type":"CDM"},{"code":"361","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LESION-PhHOS","code_information":[{"code":"2811255","type":"CDM"},{"code":"361","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.25,"setting":"both","billing_class":"facility"},{"gross_charge":309.25,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID FB-PhHOS","code_information":[{"code":"2811256","type":"CDM"},{"code":"361","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"facility"},{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN EXERNAL EAR LES-PhHOS","code_information":[{"code":"2811257","type":"CDM"},{"code":"361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF EXERNAL EAR-PhHOS","code_information":[{"code":"2811258","type":"CDM"},{"code":"361","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"facility"},{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"REM EAR CANAL LES-PhHOS","code_information":[{"code":"2811259","type":"CDM"},{"code":"361","type":"RC"},{"code":"69145","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.75,"setting":"both","billing_class":"facility"},{"gross_charge":486.75,"setting":"both","billing_class":"professional"}]},{"description":"CLEAR OUTER EAR CANAL-PhHOS","code_information":[{"code":"2811260","type":"CDM"},{"code":"361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"CLEAR OUTER EAR CANAL-PhHOS","code_information":[{"code":"2811261","type":"CDM"},{"code":"361","type":"RC"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"facility"},{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EAR WAX-PhHOS","code_information":[{"code":"2811262","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"facility"},{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"CLEAN OUT MASTOID CAVITY-PhHOS","code_information":[{"code":"2811263","type":"CDM"},{"code":"361","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"facility"},{"gross_charge":118.5,"setting":"both","billing_class":"professional"}]},{"description":"CLEAN OUT MASTOID CAVITY-PhHOS","code_information":[{"code":"2811264","type":"CDM"},{"code":"361","type":"RC"},{"code":"69222","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISION EARDRUM-PhHOS","code_information":[{"code":"2811265","type":"CDM"},{"code":"361","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"facility"},{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION EARDRUM-PhHOS","code_information":[{"code":"2811266","type":"CDM"},{"code":"361","type":"RC"},{"code":"69421","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"facility"},{"gross_charge":255.0,"setting":"both","billing_class":"professional"}]},{"description":"REM VENTILATING TUBE-PhHOS","code_information":[{"code":"2811267","type":"CDM"},{"code":"361","type":"RC"},{"code":"69424","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.5,"setting":"both","billing_class":"professional"}]},{"description":"CREATE EARDRUM OPENING-PhHOS","code_information":[{"code":"2811268","type":"CDM"},{"code":"361","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"CREATE EARDRUM OPENING-PhHOS","code_information":[{"code":"2811269","type":"CDM"},{"code":"361","type":"RC"},{"code":"69436","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.25,"setting":"both","billing_class":"facility"},{"gross_charge":310.25,"setting":"both","billing_class":"professional"}]},{"description":"REP OF EARDRUM-PhHOS","code_information":[{"code":"2811270","type":"CDM"},{"code":"361","type":"RC"},{"code":"69610","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.5,"setting":"both","billing_class":"facility"},{"gross_charge":833.5,"setting":"both","billing_class":"professional"}]},{"description":"MICROSURG ADD-ON-PhHOS","code_information":[{"code":"2811271","type":"CDM"},{"code":"361","type":"RC"},{"code":"69990","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.75,"setting":"both","billing_class":"facility"},{"gross_charge":442.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY BILE DUCT ENDO-PhHOS","code_information":[{"code":"2811272","type":"CDM"},{"code":"361","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"CONTRST XRAY URINARY TR-PhHOS","code_information":[{"code":"2811273","type":"CDM"},{"code":"361","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY URETHRA/BLADDER-PhHOS","code_information":[{"code":"2811274","type":"CDM"},{"code":"361","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUOROSCOPE EXAMINATION-PhHOS","code_information":[{"code":"2811275","type":"CDM"},{"code":"361","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"US ABD BACK WALL LIM-PhHOS","code_information":[{"code":"2811276","type":"CDM"},{"code":"361","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"FETAL BIOPH PROF W/O NST-PhHOS","code_information":[{"code":"2811277","type":"CDM"},{"code":"361","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"US GUIDE VASCULAR ACCESS-PhHOS","code_information":[{"code":"2811278","type":"CDM"},{"code":"361","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"facility"},{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUOROGUIDE FOR VEIN DEV-PhHOS","code_information":[{"code":"2811279","type":"CDM"},{"code":"361","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.75,"setting":"both","billing_class":"facility"},{"gross_charge":34.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUOROGUIDE NEEDLE PL-PhHOS","code_information":[{"code":"2811280","type":"CDM"},{"code":"361","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERACTIVE COMPLEX ADDL-PhHOS","code_information":[{"code":"2811281","type":"CDM"},{"code":"361","type":"RC"},{"code":"90785","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"facility"},{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"PSY DX EVALUATION-PhHOS","code_information":[{"code":"2811282","type":"CDM"},{"code":"361","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"PSY DX EVAL W/MED SERV-PhHOS","code_information":[{"code":"2811283","type":"CDM"},{"code":"361","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"setting":"both","billing_class":"facility"},{"gross_charge":254.0,"setting":"both","billing_class":"professional"}]},{"description":"G ESOPH REFLX W/ELECTROD-READ","code_information":[{"code":"2811284","type":"CDM"},{"code":"361","type":"RC"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"facility"},{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"EXRACRANIAL STUDY-PhHOS","code_information":[{"code":"2811287","type":"CDM"},{"code":"361","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"EXREMITY STUDY-PhHOS","code_information":[{"code":"2811288","type":"CDM"},{"code":"361","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"EXREMITY STUDY-PhHOS","code_information":[{"code":"2811289","type":"CDM"},{"code":"361","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"LOWER EXREMITY STUDY-PhHOS","code_information":[{"code":"2811290","type":"CDM"},{"code":"361","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"facility"},{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"EXREMITY STUDY-PhHOS","code_information":[{"code":"2811291","type":"CDM"},{"code":"361","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"facility"},{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"EXREMITY STUDY-PhHOS","code_information":[{"code":"2811292","type":"CDM"},{"code":"361","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"DOPPLER FLOW TESTING-PhHOS","code_information":[{"code":"2811293","type":"CDM"},{"code":"361","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"facility"},{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"BREATHING CAPACITY TEST-PhHOS","code_information":[{"code":"2811294","type":"CDM"},{"code":"361","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"facility"},{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"EVAL/WHEEZ BRNCDILAT ADMN-READ","code_information":[{"code":"2811295","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"facility"},{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"EVAL/WHEEZING W/ADMN AGT-READ","code_information":[{"code":"2811296","type":"CDM"},{"code":"460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"facility"},{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"EXHALED AIR ANALYSIS-PhHOS","code_information":[{"code":"2811297","type":"CDM"},{"code":"361","type":"RC"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.25,"setting":"both","billing_class":"facility"},{"gross_charge":8.25,"setting":"both","billing_class":"professional"}]},{"description":"CO/MEMBANE DIFFUSE CAP-READ","code_information":[{"code":"2811299","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"facility"},{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"SLP STDY UNATTENDED-PhHOS","code_information":[{"code":"2811300","type":"CDM"},{"code":"361","type":"RC"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.5,"setting":"both","billing_class":"facility"},{"gross_charge":328.5,"setting":"both","billing_class":"professional"}]},{"description":"SLP STDY UNATND W/ANAL-PhHOS","code_information":[{"code":"2811301","type":"CDM"},{"code":"361","type":"RC"},{"code":"95801","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"RANGE OF MOTION MEASUREM-PhHOS","code_information":[{"code":"2811312","type":"CDM"},{"code":"361","type":"RC"},{"code":"95851","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"facility"},{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"VISUAL EVOKED POTENTIAL-PhHOS","code_information":[{"code":"2811313","type":"CDM"},{"code":"361","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"WND CARE/20CM OR <-PhHOS","code_information":[{"code":"2811316","type":"CDM"},{"code":"361","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"ACTIVE WND CARE > 20CM-PhHOS","code_information":[{"code":"2811317","type":"CDM"},{"code":"361","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX < 50CM-PhHOS","code_information":[{"code":"2811318","type":"CDM"},{"code":"361","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":49.0,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX > 50CM-PhHOS","code_information":[{"code":"2811319","type":"CDM"},{"code":"361","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":49.0,"setting":"both","billing_class":"professional"}]},{"description":"MED NUTRITION INDIV IN-PhHOS","code_information":[{"code":"2811320","type":"CDM"},{"code":"361","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"MED NUTRITION INDIV SUBQ-PhHOS","code_information":[{"code":"2811321","type":"CDM"},{"code":"361","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MANIPULATION-PhHOS","code_information":[{"code":"2811322","type":"CDM"},{"code":"361","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MANIPULATION-PhHOS","code_information":[{"code":"2811323","type":"CDM"},{"code":"361","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MANIPULATION-PhHOS","code_information":[{"code":"2811324","type":"CDM"},{"code":"361","type":"RC"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT NEW-PhHOS","code_information":[{"code":"2811326","type":"CDM"},{"code":"361","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"facility"},{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT NEW-PhHOS","code_information":[{"code":"2811327","type":"CDM"},{"code":"361","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT NEW-PhHOS","code_information":[{"code":"2811328","type":"CDM"},{"code":"361","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.5,"setting":"both","billing_class":"facility"},{"gross_charge":217.5,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT NEW-PhHOS","code_information":[{"code":"2811329","type":"CDM"},{"code":"361","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","billing_class":"facility"},{"gross_charge":272.5,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT EST-PhHOS","code_information":[{"code":"2811330","type":"CDM"},{"code":"361","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT EST-PhHOS","code_information":[{"code":"2811331","type":"CDM"},{"code":"361","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT EST-PhHOS","code_information":[{"code":"2811332","type":"CDM"},{"code":"361","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT EST-PhHOS","code_information":[{"code":"2811333","type":"CDM"},{"code":"361","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"setting":"both","billing_class":"facility"},{"gross_charge":151.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE/OUTPT VISIT EST-PhHOS","code_information":[{"code":"2811334","type":"CDM"},{"code":"361","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"facility"},{"gross_charge":192.0,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL HOSPITAL CARE-PhHOS","code_information":[{"code":"2811339","type":"CDM"},{"code":"361","type":"RC"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"facility"},{"gross_charge":133.75,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL HOSPITAL CARE-PhHOS","code_information":[{"code":"2811340","type":"CDM"},{"code":"361","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL HOSPITAL CARE-PhHOS","code_information":[{"code":"2811341","type":"CDM"},{"code":"361","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"facility"},{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"SUBSEQ HOSPITAL CARE-PhHOS","code_information":[{"code":"2811345","type":"CDM"},{"code":"361","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"SUBSEQ HOSPITAL CARE-PhHOS","code_information":[{"code":"2811346","type":"CDM"},{"code":"361","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"facility"},{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"SUBSEQ HOSPITAL CARE-PhHOS","code_information":[{"code":"2811347","type":"CDM"},{"code":"361","type":"RC"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"OBSERV/HOSP SAME DATE-PhHOS","code_information":[{"code":"2811348","type":"CDM"},{"code":"361","type":"RC"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"facility"},{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"OBSERV/HOSP SAME DATE-PhHOS","code_information":[{"code":"2811349","type":"CDM"},{"code":"361","type":"RC"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"OBSERV/HOSP SAME DATE-PhHOS","code_information":[{"code":"2811350","type":"CDM"},{"code":"361","type":"RC"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"setting":"both","billing_class":"facility"},{"gross_charge":398.0,"setting":"both","billing_class":"professional"}]},{"description":"HOSPITAL DISCHARGE DAY-PhHOS","code_information":[{"code":"2811351","type":"CDM"},{"code":"361","type":"RC"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"HOSPITAL DISCHARGE DAY-PhHOS","code_information":[{"code":"2811352","type":"CDM"},{"code":"361","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"facility"},{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL INPAT CONSULT-PhHOS","code_information":[{"code":"2811355","type":"CDM"},{"code":"361","type":"RC"},{"code":"99252","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"facility"},{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL INPAT CONSULT-PhHOS","code_information":[{"code":"2811356","type":"CDM"},{"code":"361","type":"RC"},{"code":"99253","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"facility"},{"gross_charge":212.25,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL INPAT CONSULT-PhHOS","code_information":[{"code":"2811357","type":"CDM"},{"code":"361","type":"RC"},{"code":"99254","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.25,"setting":"both","billing_class":"facility"},{"gross_charge":308.25,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL INPAT CONSULT-PhHOS","code_information":[{"code":"2811358","type":"CDM"},{"code":"361","type":"RC"},{"code":"99255","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.5,"setting":"both","billing_class":"facility"},{"gross_charge":371.5,"setting":"both","billing_class":"professional"}]},{"description":"EMERGENCY DEPT VISIT-PhHOS","code_information":[{"code":"2811359","type":"CDM"},{"code":"361","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"EMERGENCY DEPT VISIT-PhHOS","code_information":[{"code":"2811360","type":"CDM"},{"code":"361","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"EMERGENCY DEPT VISIT-PhHOS","code_information":[{"code":"2811361","type":"CDM"},{"code":"361","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"EMERGENCY DEPT VISIT-PhHOS","code_information":[{"code":"2811362","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"CRITICAL CARE 1ST HOUR-PhHOS","code_information":[{"code":"2811363","type":"CDM"},{"code":"361","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"CRITICAL CARE ADDL 30M-PhHOS","code_information":[{"code":"2811364","type":"CDM"},{"code":"361","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"facility"},{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR T/A/L ADDON-PhHOSP","code_information":[{"code":"2811372","type":"CDM"},{"code":"361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"LIGATION ABDOMEN ARTERY-PhHOSP","code_information":[{"code":"2811373","type":"CDM"},{"code":"361","type":"RC"},{"code":"37617","type":"HCPCS"}],"standard_charges":[{"gross_charge":2476.75,"setting":"both","billing_class":"facility"},{"gross_charge":2476.75,"setting":"both","billing_class":"professional"}]},{"description":"RMVL EXCESS SKIN&TISSUE-PhHOSP","code_information":[{"code":"2811374","type":"CDM"},{"code":"361","type":"RC"},{"code":"15839","type":"HCPCS"}],"standard_charges":[{"gross_charge":1393.5,"setting":"both","billing_class":"facility"},{"gross_charge":1393.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL LENS MATERIAL-PhHOSP","code_information":[{"code":"2811375","type":"CDM"},{"code":"361","type":"RC"},{"code":"66850","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.5,"setting":"both","billing_class":"facility"},{"gross_charge":1452.5,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE BX LYMPH NODES-PhHOSP","code_information":[{"code":"2811376","type":"CDM"},{"code":"361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.25,"setting":"both","billing_class":"facility"},{"gross_charge":160.25,"setting":"both","billing_class":"professional"}]},{"description":"PELVIC EXAM W/ANESTHESI-PhHOSP","code_information":[{"code":"2811377","type":"CDM"},{"code":"361","type":"RC"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOURETERO W/RNL STRICT-PhHO","code_information":[{"code":"2811378","type":"CDM"},{"code":"360","type":"RC"},{"code":"52346","type":"HCPCS"}],"standard_charges":[{"gross_charge":841.5,"setting":"both","billing_class":"facility"},{"gross_charge":841.5,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE NON-TUN CVAD CATH-PhHO","code_information":[{"code":"2811379","type":"CDM"},{"code":"361","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"facility"},{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"PROLONGED SERV INPATIENT-PhHOS","code_information":[{"code":"2811380","type":"CDM"},{"code":"361","type":"RC"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.25,"setting":"both","billing_class":"facility"},{"gross_charge":165.25,"setting":"both","billing_class":"professional"}]},{"description":"PHYSICIAN STANDBY SERV-PhHOS","code_information":[{"code":"2811382","type":"CDM"},{"code":"361","type":"RC"},{"code":"99360","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL CARE NORMAL NEWB-PhHOS","code_information":[{"code":"2811383","type":"CDM"},{"code":"361","type":"RC"},{"code":"99460","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.5,"setting":"both","billing_class":"facility"},{"gross_charge":166.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED MUSCSKEL GEN PX-PhHOS","code_information":[{"code":"2811384","type":"CDM"},{"code":"361","type":"RC"},{"code":"20999","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.75,"setting":"both","billing_class":"facility"},{"gross_charge":496.75,"setting":"both","billing_class":"professional"}]},{"description":"NORMAL NEWB CARE/HOSP-PhHOS","code_information":[{"code":"2811385","type":"CDM"},{"code":"361","type":"RC"},{"code":"99462","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"NB DC DAY HOSP/BRTH CNTR-PhHOS","code_information":[{"code":"2811386","type":"CDM"},{"code":"361","type":"RC"},{"code":"99463","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.25,"setting":"both","billing_class":"facility"},{"gross_charge":210.25,"setting":"both","billing_class":"professional"}]},{"description":"ATTENDANCE BIRTH-PhHOS","code_information":[{"code":"2811387","type":"CDM"},{"code":"361","type":"RC"},{"code":"99464","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.75,"setting":"both","billing_class":"facility"},{"gross_charge":139.75,"setting":"both","billing_class":"professional"}]},{"description":"NEWBORN RESUSCITATION-PhHOS","code_information":[{"code":"2811388","type":"CDM"},{"code":"361","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.5,"setting":"both","billing_class":"facility"},{"gross_charge":268.5,"setting":"both","billing_class":"professional"}]},{"description":"INPT NEONAT CARE <28DAYS-PhHOS","code_information":[{"code":"2811389","type":"CDM"},{"code":"361","type":"RC"},{"code":"99468","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.5,"setting":"both","billing_class":"facility"},{"gross_charge":1748.5,"setting":"both","billing_class":"professional"}]},{"description":"CA SCR FLEXI SIGMOIDSC-PhHOS","code_information":[{"code":"2811393","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"facility"},{"gross_charge":121.5,"setting":"both","billing_class":"professional"}]},{"description":"COLORECT SCRN;HI RSK IND-PhHOS","code_information":[{"code":"2811394","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"facility"},{"gross_charge":412.25,"setting":"both","billing_class":"professional"}]},{"description":"COLON CA SCRN NOT HI RSK-PhHOS","code_information":[{"code":"2811395","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.25,"setting":"both","billing_class":"facility"},{"gross_charge":768.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRO-PhHOS","code_information":[{"code":"2811396","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0289","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"BONE MARROW ASP &BX-PhHOS","code_information":[{"code":"2811397","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"ADJUSTMENT GASTRIC BAND-PhHOS","code_information":[{"code":"2811398","type":"CDM"},{"code":"361","type":"RC"},{"code":"S2083","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.75,"setting":"both","billing_class":"facility"},{"gross_charge":139.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTP LEVEL3 NEW-PhHOSP","code_information":[{"code":"2811399","type":"CDM"},{"code":"361","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":143.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL OUTPT VISIT EST-PhHOSP","code_information":[{"code":"2811400","type":"CDM"},{"code":"361","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTPT VISIT EST-PhHOSP","code_information":[{"code":"2811401","type":"CDM"},{"code":"361","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"facility"},{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTPT VISIT EST-PhHOSP","code_information":[{"code":"2811402","type":"CDM"},{"code":"361","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"facility"},{"gross_charge":192.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTPT VISIT EST-PhHOSP","code_information":[{"code":"2811404","type":"CDM"},{"code":"361","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"RPR/GRAFT ACHILES TENDON-PhHOS","code_information":[{"code":"2811405","type":"CDM"},{"code":"360","type":"RC"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"setting":"both","billing_class":"facility"},{"gross_charge":1325.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR/GRAFT RADIUS/ULNA-PhHOS","code_information":[{"code":"2811406","type":"CDM"},{"code":"360","type":"RC"},{"code":"25405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.25,"setting":"both","billing_class":"facility"},{"gross_charge":2044.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FT LES/TUMOR W/GRAFT-PhHOS","code_information":[{"code":"2811407","type":"CDM"},{"code":"360","type":"RC"},{"code":"28103","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"setting":"both","billing_class":"facility"},{"gross_charge":763.0,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE OF CYSTOSTOMY-PhHOS","code_information":[{"code":"2811408","type":"CDM"},{"code":"360","type":"RC"},{"code":"51880","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"setting":"both","billing_class":"facility"},{"gross_charge":913.0,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LESIONS BIL-PhHOS","code_information":[{"code":"2811409","type":"CDM"},{"code":"361","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":463.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BLEPHAROPLASTY UP LID BIL-PhHO","code_information":[{"code":"2811410","type":"CDM"},{"code":"360","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1615.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1615.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAP HERN REP INITIAL BIL-PhHOS","code_information":[{"code":"2811411","type":"CDM"},{"code":"360","type":"RC"},{"code":"49650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1283.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAP HERN REP RECUR BIL-PhHOS","code_information":[{"code":"2811412","type":"CDM"},{"code":"360","type":"RC"},{"code":"49651","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1675.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NPS SURG DILT EUST TUBE-PhHOS","code_information":[{"code":"2811413","type":"CDM"},{"code":"360","type":"RC"},{"code":"69705","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.75,"setting":"both","billing_class":"facility"},{"gross_charge":338.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ B1 SUB MTRL SBCHDRL-PhHOS","code_information":[{"code":"2811414","type":"CDM"},{"code":"360","type":"RC"},{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3775.25,"setting":"both","billing_class":"facility"},{"gross_charge":3775.25,"setting":"both","billing_class":"professional"}]},{"description":"TPRNL PLMT BIODEGR MATRL-PhHOS","code_information":[{"code":"2811415","type":"CDM"},{"code":"361","type":"RC"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.25,"setting":"both","billing_class":"facility"},{"gross_charge":314.25,"setting":"both","billing_class":"professional"}]},{"description":"PLACE DEV/MARKER-PhHOS","code_information":[{"code":"2811416","type":"CDM"},{"code":"361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.75,"setting":"both","billing_class":"facility"},{"gross_charge":190.75,"setting":"both","billing_class":"professional"}]},{"description":"IMPLANT NEUROELECTRODES-PhHOS","code_information":[{"code":"2811417","type":"CDM"},{"code":"361","type":"RC"},{"code":"64581","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.75,"setting":"both","billing_class":"facility"},{"gross_charge":1251.75,"setting":"both","billing_class":"professional"}]},{"description":"REM/INSERT DRUG IMPLANT-PhHOS","code_information":[{"code":"2811418","type":"CDM"},{"code":"361","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"facility"},{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"LAP INSERT INTRAPER CATH-PhHOS","code_information":[{"code":"2811419","type":"CDM"},{"code":"361","type":"RC"},{"code":"49324","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.5,"setting":"both","billing_class":"facility"},{"gross_charge":734.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROPLASTY KNEE-PhHOSP","code_information":[{"code":"2811420","type":"CDM"},{"code":"361","type":"RC"},{"code":"27442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.25,"setting":"both","billing_class":"facility"},{"gross_charge":1634.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROPLASTY KN W DEBRI-PhHOSP","code_information":[{"code":"2811421","type":"CDM"},{"code":"361","type":"RC"},{"code":"27443","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.0,"setting":"both","billing_class":"facility"},{"gross_charge":1527.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROPLASTY KNEE MED/L-PhHOSP","code_information":[{"code":"2811422","type":"CDM"},{"code":"361","type":"RC"},{"code":"27446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"setting":"both","billing_class":"facility"},{"gross_charge":2183.0,"setting":"both","billing_class":"professional"}]},{"description":"SIALOLITHOTOMY-PhHOSP","code_information":[{"code":"2811423","type":"CDM"},{"code":"361","type":"RC"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.25,"setting":"both","billing_class":"facility"},{"gross_charge":308.25,"setting":"both","billing_class":"professional"}]},{"description":"DIL URETH STRICT/VN-PhHOSP","code_information":[{"code":"2811424","type":"CDM"},{"code":"361","type":"RC"},{"code":"53605","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"},{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"IMPLANT NEUROELECTRODES-PhHOS","code_information":[{"code":"2811425","type":"CDM"},{"code":"361","type":"RC"},{"code":"64561","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.75,"setting":"both","billing_class":"facility"},{"gross_charge":591.75,"setting":"both","billing_class":"professional"}]},{"description":"PERC NEPHROSTOLITHOTOMY-PhHOS","code_information":[{"code":"2811426","type":"CDM"},{"code":"361","type":"RC"},{"code":"50081","type":"HCPCS"}],"standard_charges":[{"gross_charge":2412.5,"setting":"both","billing_class":"facility"},{"gross_charge":2412.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROSC KNEE W MEN REP-PhHOSP","code_information":[{"code":"2811427","type":"CDM"},{"code":"361","type":"RC"},{"code":"29883","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.25,"setting":"both","billing_class":"facility"},{"gross_charge":1590.25,"setting":"both","billing_class":"professional"}]},{"description":"CPTR ASST DIR MS PX-PhHOSP","code_information":[{"code":"2811428","type":"CDM"},{"code":"361","type":"RC"},{"code":"20985","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"facility"},{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF URETHRA-PhHOS","code_information":[{"code":"2811429","type":"CDM"},{"code":"361","type":"RC"},{"code":"53450","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.25,"setting":"both","billing_class":"facility"},{"gross_charge":773.25,"setting":"both","billing_class":"professional"}]},{"description":"ASPIRATE BLADDER W CATH-PhHOS","code_information":[{"code":"2811430","type":"CDM"},{"code":"361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"facility"},{"gross_charge":294.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC TUMOR FOREARM-PhHOSP","code_information":[{"code":"2811431","type":"CDM"},{"code":"361","type":"RC"},{"code":"25076","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.25,"setting":"both","billing_class":"facility"},{"gross_charge":972.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ MJR JNT W/US-PhHOSP","code_information":[{"code":"2811433","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY PERC HIP-PhHOSP","code_information":[{"code":"2811434","type":"CDM"},{"code":"361","type":"RC"},{"code":"27000","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"setting":"both","billing_class":"facility"},{"gross_charge":763.0,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY HIP OPEN-PhHOSP","code_information":[{"code":"2811435","type":"CDM"},{"code":"361","type":"RC"},{"code":"27006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.75,"setting":"both","billing_class":"facility"},{"gross_charge":1355.75,"setting":"both","billing_class":"professional"}]},{"description":"US GUIDED NEEDLE PLCMT-PhHOS","code_information":[{"code":"2811436","type":"CDM"},{"code":"361","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"INSTR/REDO GASTR STIMUL-PhHOS","code_information":[{"code":"2811437","type":"CDM"},{"code":"361","type":"RC"},{"code":"64590","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.5,"setting":"both","billing_class":"facility"},{"gross_charge":576.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN SNGL LES-PhHOSP","code_information":[{"code":"2811439","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPLASTY RADIUS/ULNA-PhHOSP","code_information":[{"code":"2811440","type":"CDM"},{"code":"361","type":"RC"},{"code":"25390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.5,"setting":"both","billing_class":"facility"},{"gross_charge":1444.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF DIGIT NERVE 1-PhHOSP","code_information":[{"code":"2811441","type":"CDM"},{"code":"361","type":"RC"},{"code":"64831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.5,"setting":"both","billing_class":"facility"},{"gross_charge":1291.5,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE DIGITAL NRV ADDL-PhHOSP","code_information":[{"code":"2811442","type":"CDM"},{"code":"361","type":"RC"},{"code":"64832","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.5,"setting":"both","billing_class":"facility"},{"gross_charge":635.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN ADDL-PhHOSP","code_information":[{"code":"2811443","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FRACTURE-PhHOSP","code_information":[{"code":"2811444","type":"CDM"},{"code":"361","type":"RC"},{"code":"24546","type":"HCPCS"}],"standard_charges":[{"gross_charge":1954.5,"setting":"both","billing_class":"facility"},{"gross_charge":1954.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT PLEURAL CATH-PhHOSP","code_information":[{"code":"2811445","type":"CDM"},{"code":"361","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.75,"setting":"both","billing_class":"facility"},{"gross_charge":390.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED NERV SYST PROC-PhHOSP","code_information":[{"code":"2811446","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHR ACETABULOPSTY-PhHOSP","code_information":[{"code":"2811447","type":"CDM"},{"code":"361","type":"RC"},{"code":"29915","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.5,"setting":"both","billing_class":"facility"},{"gross_charge":1905.5,"setting":"both","billing_class":"professional"}]},{"description":"VAG DELIVERY AFTR C-SEC-PhHOSP","code_information":[{"code":"2811448","type":"CDM"},{"code":"361","type":"RC"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"setting":"both","billing_class":"facility"},{"gross_charge":2031.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED LAP HERNIA PROC-PhHOS","code_information":[{"code":"2811449","type":"CDM"},{"code":"361","type":"RC"},{"code":"49659","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.5,"setting":"both","billing_class":"facility"},{"gross_charge":789.5,"setting":"both","billing_class":"professional"}]},{"description":"POST CATARACT LASER-PhHOSP","code_information":[{"code":"2811451","type":"CDM"},{"code":"361","type":"RC"},{"code":"66821","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.5,"setting":"both","billing_class":"facility"},{"gross_charge":578.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTR PROSTATE TISS-PhHOSP","code_information":[{"code":"2811452","type":"CDM"},{"code":"361","type":"RC"},{"code":"53854","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"setting":"both","billing_class":"facility"},{"gross_charge":711.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO W STEROID-PhHOSP","code_information":[{"code":"2811453","type":"CDM"},{"code":"361","type":"RC"},{"code":"52283","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"facility"},{"gross_charge":380.5,"setting":"both","billing_class":"professional"}]},{"description":"INS PENILE PROSTHESIS-PhHOSP","code_information":[{"code":"2811454","type":"CDM"},{"code":"361","type":"RC"},{"code":"54401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.5,"setting":"both","billing_class":"facility"},{"gross_charge":1239.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGOSCP RIG BX-PhHOSP","code_information":[{"code":"2811455","type":"CDM"},{"code":"361","type":"RC"},{"code":"43193","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"facility"},{"gross_charge":319.5,"setting":"both","billing_class":"professional"}]},{"description":"RESECT SM INT-PhHOSP","code_information":[{"code":"2811456","type":"CDM"},{"code":"361","type":"RC"},{"code":"44125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"setting":"both","billing_class":"facility"},{"gross_charge":2232.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROSCOPY WRIST-PhHOSP","code_information":[{"code":"2811457","type":"CDM"},{"code":"361","type":"RC"},{"code":"29846","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.25,"setting":"both","billing_class":"facility"},{"gross_charge":977.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTECTOMY PARTIAL-PhHOS","code_information":[{"code":"2811458","type":"CDM"},{"code":"361","type":"RC"},{"code":"51550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1820.75,"setting":"both","billing_class":"facility"},{"gross_charge":1820.75,"setting":"both","billing_class":"professional"}]},{"description":"CLSR EV FISTULA-PhHOSP","code_information":[{"code":"2811459","type":"CDM"},{"code":"361","type":"RC"},{"code":"44661","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.75,"setting":"both","billing_class":"facility"},{"gross_charge":2935.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRODESIS SACROILIAC-PhHOSP","code_information":[{"code":"2811460","type":"CDM"},{"code":"361","type":"RC"},{"code":"27279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1304.75,"setting":"both","billing_class":"facility"},{"gross_charge":1304.75,"setting":"both","billing_class":"professional"}]},{"description":"REP FLXR TENDON-PhHOSP","code_information":[{"code":"2811461","type":"CDM"},{"code":"361","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.75,"setting":"both","billing_class":"facility"},{"gross_charge":1308.75,"setting":"both","billing_class":"professional"}]},{"description":"CATRCT REM-PhHOSP","code_information":[{"code":"2811462","type":"CDM"},{"code":"361","type":"RC"},{"code":"66984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.25,"setting":"both","billing_class":"facility"},{"gross_charge":1185.25,"setting":"both","billing_class":"professional"}]},{"description":"CATRCT REM CMPLX-PhHOSP","code_information":[{"code":"2811463","type":"CDM"},{"code":"361","type":"RC"},{"code":"66982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"setting":"both","billing_class":"facility"},{"gross_charge":1473.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TUN IP CATH-PhHOSP","code_information":[{"code":"2811464","type":"CDM"},{"code":"361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility"},{"gross_charge":384.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED MECKEL DIVERT-PhHOSP","code_information":[{"code":"2811465","type":"CDM"},{"code":"361","type":"RC"},{"code":"44899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"setting":"both","billing_class":"facility"},{"gross_charge":1020.0,"setting":"both","billing_class":"professional"}]},{"description":"MYOMECTOMY ABD METH-PhHOSP","code_information":[{"code":"2811466","type":"CDM"},{"code":"361","type":"RC"},{"code":"58140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.5,"setting":"both","billing_class":"facility"},{"gross_charge":1708.5,"setting":"both","billing_class":"professional"}]},{"description":"LIGAMENT AUGM KNEE-PhHOSP","code_information":[{"code":"2811467","type":"CDM"},{"code":"361","type":"RC"},{"code":"27427","type":"HCPCS"}],"standard_charges":[{"gross_charge":1337.25,"setting":"both","billing_class":"facility"},{"gross_charge":1337.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE HIP PROSTHESIS-PhHOSP","code_information":[{"code":"2811468","type":"CDM"},{"code":"361","type":"RC"},{"code":"27090","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.75,"setting":"both","billing_class":"facility"},{"gross_charge":1562.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC PLVS/HIP-PhHOSP","code_information":[{"code":"2811469","type":"CDM"},{"code":"361","type":"RC"},{"code":"27299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"setting":"both","billing_class":"facility"},{"gross_charge":1530.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED HUM/ELB PROC-PhHOSP","code_information":[{"code":"2811470","type":"CDM"},{"code":"361","type":"RC"},{"code":"24999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"setting":"both","billing_class":"facility"},{"gross_charge":1530.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED FEM GENIT PROC-PhHOSP","code_information":[{"code":"2811471","type":"CDM"},{"code":"361","type":"RC"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"setting":"both","billing_class":"facility"},{"gross_charge":1530.0,"setting":"both","billing_class":"professional"}]},{"description":"PROPHYL TX FEM NECK-PhHOSP","code_information":[{"code":"2811472","type":"CDM"},{"code":"361","type":"RC"},{"code":"27187","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.75,"setting":"both","billing_class":"facility"},{"gross_charge":1869.75,"setting":"both","billing_class":"professional"}]},{"description":"SLIT PREPUCE NEWBORN-PhHOSP","code_information":[{"code":"2811474","type":"CDM"},{"code":"361","type":"RC"},{"code":"54000","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"facility"},{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC TROCHANTERIC BURSA-PhHOSP","code_information":[{"code":"2811475","type":"CDM"},{"code":"361","type":"RC"},{"code":"27062","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"setting":"both","billing_class":"facility"},{"gross_charge":856.0,"setting":"both","billing_class":"professional"}]},{"description":"REV/REM NEUROELECTRODE-PhHOS","code_information":[{"code":"2811476","type":"CDM"},{"code":"361","type":"RC"},{"code":"64585","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.75,"setting":"both","billing_class":"facility"},{"gross_charge":282.75,"setting":"both","billing_class":"professional"}]},{"description":"LAP GASTROSTOMY WO TUBE-PhHOSP","code_information":[{"code":"2811477","type":"CDM"},{"code":"361","type":"RC"},{"code":"43653","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC FEMUR-PhHOSP","code_information":[{"code":"2811478","type":"CDM"},{"code":"361","type":"RC"},{"code":"27599","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"setting":"both","billing_class":"facility"},{"gross_charge":1020.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC FOREARM-PhHOSP","code_information":[{"code":"2811479","type":"CDM"},{"code":"361","type":"RC"},{"code":"25999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"setting":"both","billing_class":"facility"},{"gross_charge":1020.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPL NRV ARM/LEG-PhHOSP","code_information":[{"code":"2811480","type":"CDM"},{"code":"361","type":"RC"},{"code":"64708","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"},{"gross_charge":941.5,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX<=50CM-PhHOSP","code_information":[{"code":"2811481","type":"CDM"},{"code":"361","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility"},{"gross_charge":384.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR PROFUNDUS TENDON-PhHOSP","code_information":[{"code":"2811482","type":"CDM"},{"code":"361","type":"RC"},{"code":"26370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.25,"setting":"both","billing_class":"facility"},{"gross_charge":1389.25,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED STOMACH PROC-PhHOSP","code_information":[{"code":"2811483","type":"CDM"},{"code":"361","type":"RC"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"setting":"both","billing_class":"facility"},{"gross_charge":1530.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR TRNK/ARM/LG-PhHOSP","code_information":[{"code":"2811484","type":"CDM"},{"code":"361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY LWR LID-PhHOSP","code_information":[{"code":"2811485","type":"CDM"},{"code":"361","type":"RC"},{"code":"15820","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.75,"setting":"both","billing_class":"facility"},{"gross_charge":953.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC VAR/LIGA SPERM VEIN-PhHOS","code_information":[{"code":"2811486","type":"CDM"},{"code":"361","type":"RC"},{"code":"55530","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.25,"setting":"both","billing_class":"facility"},{"gross_charge":665.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY LWR LID-PhHOSP","code_information":[{"code":"2811487","type":"CDM"},{"code":"361","type":"RC"},{"code":"15821","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"setting":"both","billing_class":"facility"},{"gross_charge":1015.0,"setting":"both","billing_class":"professional"}]},{"description":"BX/EXC LYMPH NODES OPEN-PhHOSP","code_information":[{"code":"2811488","type":"CDM"},{"code":"361","type":"RC"},{"code":"38531","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.25,"setting":"both","billing_class":"facility"},{"gross_charge":823.25,"setting":"both","billing_class":"professional"}]},{"description":"NASOPHARYNGOSCOPY-PhHOSP","code_information":[{"code":"2811489","type":"CDM"},{"code":"361","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.25,"setting":"both","billing_class":"facility"},{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED MDDL EAR PROC-PhHOSP","code_information":[{"code":"2811490","type":"CDM"},{"code":"361","type":"RC"},{"code":"69799","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"PIN PLATE/WIRE TIBIA-PhHOSP","code_information":[{"code":"2811491","type":"CDM"},{"code":"361","type":"RC"},{"code":"27745","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility"},{"gross_charge":1419.0,"setting":"both","billing_class":"professional"}]},{"description":"REV/RMV PERI/GAST STIM-PhHOS","code_information":[{"code":"2811492","type":"CDM"},{"code":"361","type":"RC"},{"code":"64595","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"setting":"both","billing_class":"facility"},{"gross_charge":450.0,"setting":"both","billing_class":"professional"}]},{"description":"CL TX HUMERUS FX-PhHOSP","code_information":[{"code":"2811493","type":"CDM"},{"code":"361","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.5,"setting":"both","billing_class":"facility"},{"gross_charge":943.5,"setting":"both","billing_class":"professional"}]},{"description":"REM LUNG CATHETER-PhHOSP","code_information":[{"code":"2811494","type":"CDM"},{"code":"361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"setting":"both","billing_class":"facility"},{"gross_charge":298.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HEEL FX-PhHOSP","code_information":[{"code":"2811495","type":"CDM"},{"code":"361","type":"RC"},{"code":"28415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2099.25,"setting":"both","billing_class":"facility"},{"gross_charge":2099.25,"setting":"both","billing_class":"professional"}]},{"description":"GASTROSTOMY W/ TUBE-PhHOSP","code_information":[{"code":"2811496","type":"CDM"},{"code":"361","type":"RC"},{"code":"43832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.5,"setting":"both","billing_class":"facility"},{"gross_charge":1963.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANSECT SPINAL NRV-PhHOSP","code_information":[{"code":"2811497","type":"CDM"},{"code":"361","type":"RC"},{"code":"64772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"setting":"both","billing_class":"facility"},{"gross_charge":1118.0,"setting":"both","billing_class":"professional"}]},{"description":"DILATE CERVICAL CANAL-PhHOSP","code_information":[{"code":"2811498","type":"CDM"},{"code":"361","type":"RC"},{"code":"57800","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"RESUSCITATION-PhHOSP","code_information":[{"code":"2811499","type":"CDM"},{"code":"361","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"TRANSECT/AV LINGUAL NRV-PhHOSP","code_information":[{"code":"2811500","type":"CDM"},{"code":"361","type":"RC"},{"code":"64740","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"setting":"both","billing_class":"facility"},{"gross_charge":915.0,"setting":"both","billing_class":"professional"}]},{"description":"FASCIOTOMY HIP/THIGH-PhHOSP","code_information":[{"code":"2811501","type":"CDM"},{"code":"361","type":"RC"},{"code":"27025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.75,"setting":"both","billing_class":"facility"},{"gross_charge":1720.75,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH EBUS 1 OR 2 NODE-PhHOSP","code_information":[{"code":"2811502","type":"CDM"},{"code":"361","type":"RC"},{"code":"31652","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.25,"setting":"both","billing_class":"facility"},{"gross_charge":417.25,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH EBUS 3/> NODE-PhHOSP","code_information":[{"code":"2811503","type":"CDM"},{"code":"361","type":"RC"},{"code":"31653","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.25,"setting":"both","billing_class":"facility"},{"gross_charge":462.25,"setting":"both","billing_class":"professional"}]},{"description":"BRONCH EBUS INTV PERPH-PhHOSP","code_information":[{"code":"2811504","type":"CDM"},{"code":"361","type":"RC"},{"code":"31654","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.5,"setting":"both","billing_class":"facility"},{"gross_charge":127.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTD PROC HAND/FNGER-PhHOSP","code_information":[{"code":"2811505","type":"CDM"},{"code":"361","type":"RC"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"setting":"both","billing_class":"facility"},{"gross_charge":1224.0,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROTOMY SM INT-PhHOSP","code_information":[{"code":"2811506","type":"CDM"},{"code":"361","type":"RC"},{"code":"44020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.5,"setting":"both","billing_class":"facility"},{"gross_charge":1852.5,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE GASTROSTOMY-PhHOSP","code_information":[{"code":"2811507","type":"CDM"},{"code":"361","type":"RC"},{"code":"43870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.5,"setting":"both","billing_class":"facility"},{"gross_charge":1349.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGOSCOPY CTRL BL-PhHOSP","code_information":[{"code":"2811508","type":"CDM"},{"code":"361","type":"RC"},{"code":"43227","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.25,"setting":"both","billing_class":"facility"},{"gross_charge":310.25,"setting":"both","billing_class":"professional"}]},{"description":"UMBILECTOMY OMPHALECT-PhHOS","code_information":[{"code":"2811509","type":"CDM"},{"code":"361","type":"RC"},{"code":"49250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"setting":"both","billing_class":"facility"},{"gross_charge":1116.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE TUNNELED IP CATH-PhHOSP","code_information":[{"code":"2811510","type":"CDM"},{"code":"361","type":"RC"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.5,"setting":"both","billing_class":"facility"},{"gross_charge":422.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED ANUS PROC-PhHOSP","code_information":[{"code":"2811511","type":"CDM"},{"code":"361","type":"RC"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.75,"setting":"both","billing_class":"facility"},{"gross_charge":851.75,"setting":"both","billing_class":"professional"}]},{"description":"RECONSTR QUAD/HMST MSCL-PhHOSP","code_information":[{"code":"2811512","type":"CDM"},{"code":"361","type":"RC"},{"code":"27386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1592.25,"setting":"both","billing_class":"facility"},{"gross_charge":1592.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC NEUROFIBROM CUT NRV-PhHOSP","code_information":[{"code":"2811513","type":"CDM"},{"code":"361","type":"RC"},{"code":"64788","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"setting":"both","billing_class":"facility"},{"gross_charge":758.0,"setting":"both","billing_class":"professional"}]},{"description":"TX HUMERUS EPICOND FX-PhHOSP","code_information":[{"code":"2811514","type":"CDM"},{"code":"361","type":"RC"},{"code":"24575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.25,"setting":"both","billing_class":"facility"},{"gross_charge":1379.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR EXT ECTROPIAN-PhHOSP","code_information":[{"code":"2811515","type":"CDM"},{"code":"361","type":"RC"},{"code":"67917","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.75,"setting":"both","billing_class":"facility"},{"gross_charge":844.75,"setting":"both","billing_class":"professional"}]},{"description":"CATRCT REM,CM SURG-PhHOSP","code_information":[{"code":"2811516","type":"CDM"},{"code":"361","type":"RC"},{"code":"66984","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.75,"setting":"both","modifiers":"54","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 54: Surgical Care Only"},{"gross_charge":948.75,"setting":"both","modifiers":"54","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 54: Surgical Care Only"}]},{"description":"CATRCT REM,CM PO-PhHOSP","code_information":[{"code":"2811517","type":"CDM"},{"code":"361","type":"RC"},{"code":"66984","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.75,"setting":"both","modifiers":"55","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 55: Postoperative Management Only"},{"gross_charge":236.75,"setting":"both","modifiers":"55","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 55: Postoperative Management Only"}]},{"description":"CATRCT REM CMPX,CM SURG-PhHOSP","code_information":[{"code":"2811518","type":"CDM"},{"code":"361","type":"RC"},{"code":"66982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.25,"setting":"both","modifiers":"54","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 54: Surgical Care Only"},{"gross_charge":1178.25,"setting":"both","modifiers":"54","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 54: Surgical Care Only"}]},{"description":"CATRCT REM CMPX,CM PO-PhHOSP","code_information":[{"code":"2811519","type":"CDM"},{"code":"361","type":"RC"},{"code":"66982","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"setting":"both","modifiers":"55","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 55: Postoperative Management Only"},{"gross_charge":295.0,"setting":"both","modifiers":"55","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 55: Postoperative Management Only"}]},{"description":"ROBOTIC SURGICAL SYSTEM-PhHOSP","code_information":[{"code":"2811520","type":"CDM"},{"code":"361","type":"RC"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"MANIP ELBOW W ANESTH-PhHOSP","code_information":[{"code":"2811521","type":"CDM"},{"code":"361","type":"RC"},{"code":"24300","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.75,"setting":"both","billing_class":"facility"},{"gross_charge":799.75,"setting":"both","billing_class":"professional"}]},{"description":"DILATE URETHRA STRICTURE-PhHOS","code_information":[{"code":"2811522","type":"CDM"},{"code":"361","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.5,"setting":"both","billing_class":"facility"},{"gross_charge":120.5,"setting":"both","billing_class":"professional"}]},{"description":"BRONCHOSCOPY W/FB REM-PhHOSP","code_information":[{"code":"2811523","type":"CDM"},{"code":"361","type":"RC"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.5,"setting":"both","billing_class":"facility"},{"gross_charge":330.5,"setting":"both","billing_class":"professional"}]},{"description":"REVISE ILEOSTOMY-PhHOSP","code_information":[{"code":"2811524","type":"CDM"},{"code":"361","type":"RC"},{"code":"44312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.25,"setting":"both","billing_class":"facility"},{"gross_charge":1124.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRODESIS TIBIOFIBUL-PhHOSP","code_information":[{"code":"2811525","type":"CDM"},{"code":"361","type":"RC"},{"code":"27871","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.5,"setting":"both","billing_class":"facility"},{"gross_charge":1297.5,"setting":"both","billing_class":"professional"}]},{"description":"PROCTECTOMY-PhHOSP","code_information":[{"code":"2811526","type":"CDM"},{"code":"361","type":"RC"},{"code":"45111","type":"HCPCS"}],"standard_charges":[{"gross_charge":2056.5,"setting":"both","billing_class":"facility"},{"gross_charge":2056.5,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF COLOSTOMY-PhHOSP","code_information":[{"code":"2811527","type":"CDM"},{"code":"361","type":"RC"},{"code":"44340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.25,"setting":"both","billing_class":"facility"},{"gross_charge":1179.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL HYMENECTOMY-PhHOSP","code_information":[{"code":"2811528","type":"CDM"},{"code":"361","type":"RC"},{"code":"56700","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.5,"setting":"both","billing_class":"facility"},{"gross_charge":372.5,"setting":"both","billing_class":"professional"}]},{"description":"EXCISE VAGINAL SEPTUM-PhHOSP","code_information":[{"code":"2811529","type":"CDM"},{"code":"361","type":"RC"},{"code":"57130","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.75,"setting":"both","billing_class":"facility"},{"gross_charge":387.75,"setting":"both","billing_class":"professional"}]},{"description":"INS PENILE PROSTHESIS-PhHOS","code_information":[{"code":"2811530","type":"CDM"},{"code":"361","type":"RC"},{"code":"54400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.75,"setting":"both","billing_class":"facility"},{"gross_charge":1001.75,"setting":"both","billing_class":"professional"}]},{"description":"MALE SLING OPERATION-PhHOS","code_information":[{"code":"2811531","type":"CDM"},{"code":"361","type":"RC"},{"code":"53440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"setting":"both","billing_class":"facility"},{"gross_charge":1439.0,"setting":"both","billing_class":"professional"}]},{"description":"CLOSE RECTOVAGINAL FIST-PhHOSP","code_information":[{"code":"2811532","type":"CDM"},{"code":"361","type":"RC"},{"code":"57305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.0,"setting":"both","billing_class":"facility"},{"gross_charge":1825.0,"setting":"both","billing_class":"professional"}]},{"description":"PERC INC ADDUCTOR/HAMST-PhHOSP","code_information":[{"code":"2811533","type":"CDM"},{"code":"361","type":"RC"},{"code":"27306","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.75,"setting":"both","billing_class":"facility"},{"gross_charge":644.75,"setting":"both","billing_class":"professional"}]},{"description":"CSEC AFTR ATTEMP VAG-PhHOSP","code_information":[{"code":"2811534","type":"CDM"},{"code":"361","type":"RC"},{"code":"59620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"setting":"both","billing_class":"facility"},{"gross_charge":2031.0,"setting":"both","billing_class":"professional"}]},{"description":"LAP ENTERECTOMY-PhHOSP","code_information":[{"code":"2811535","type":"CDM"},{"code":"361","type":"RC"},{"code":"44202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.75,"setting":"both","billing_class":"facility"},{"gross_charge":2632.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED SMALL INTEST-PhHOSP","code_information":[{"code":"2811536","type":"CDM"},{"code":"361","type":"RC"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2589.0,"setting":"both","billing_class":"facility"},{"gross_charge":2589.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT ANT SGMNT DRAIN-PhHOSP","code_information":[{"code":"2811537","type":"CDM"},{"code":"361","type":"RC"},{"code":"0671T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4673.75,"setting":"both","billing_class":"facility"},{"gross_charge":4673.75,"setting":"both","billing_class":"professional"}]},{"description":"DCMPRN LEG ANT&/LAT&PST-PhHOSP","code_information":[{"code":"2811538","type":"CDM"},{"code":"361","type":"RC"},{"code":"27602","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"setting":"both","billing_class":"facility"},{"gross_charge":916.0,"setting":"both","billing_class":"professional"}]},{"description":"REP SCALP/NK/TR/EXT-PhHOSP","code_information":[{"code":"2811539","type":"CDM"},{"code":"361","type":"RC"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"},{"gross_charge":276.5,"setting":"both","billing_class":"professional"}]},{"description":"EXCHNG INTRAOCULAR LENS-PhHOSP","code_information":[{"code":"2811540","type":"CDM"},{"code":"361","type":"RC"},{"code":"66986","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"setting":"both","billing_class":"facility"},{"gross_charge":1674.0,"setting":"both","billing_class":"professional"}]},{"description":"TX ACROMIOCLAV DISLOC-PhHOSP","code_information":[{"code":"2811541","type":"CDM"},{"code":"361","type":"RC"},{"code":"23552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.25,"setting":"both","billing_class":"facility"},{"gross_charge":1230.25,"setting":"both","billing_class":"professional"}]},{"description":"REP WND S/TR/EXT 30PhHOSP","code_information":[{"code":"2811542","type":"CDM"},{"code":"361","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.75,"setting":"both","billing_class":"facility"},{"gross_charge":495.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC TARSAL/METATR CYST-PhHOSP","code_information":[{"code":"2811543","type":"CDM"},{"code":"361","type":"RC"},{"code":"28104","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","billing_class":"facility"},{"gross_charge":666.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FB PELVIS OR HIP;SQ-PhHOSP","code_information":[{"code":"2811544","type":"CDM"},{"code":"361","type":"RC"},{"code":"27086","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.25,"setting":"both","billing_class":"facility"},{"gross_charge":315.25,"setting":"both","billing_class":"professional"}]},{"description":"REVISE ESOPHAGUS & STOM-PhHOSP","code_information":[{"code":"2811545","type":"CDM"},{"code":"361","type":"RC"},{"code":"43325","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.75,"setting":"both","billing_class":"facility"},{"gross_charge":2585.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC CERVICAL STUMP VAG-PhHOSP","code_information":[{"code":"2811546","type":"CDM"},{"code":"361","type":"RC"},{"code":"57550","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.75,"setting":"both","billing_class":"facility"},{"gross_charge":795.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE URETER CALCULUS-PhHOSP","code_information":[{"code":"2811547","type":"CDM"},{"code":"361","type":"RC"},{"code":"51065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1091.5,"setting":"both","billing_class":"facility"},{"gross_charge":1091.5,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY HAM/KN TO HIP-PhHOSP","code_information":[{"code":"2811548","type":"CDM"},{"code":"361","type":"RC"},{"code":"27390","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.75,"setting":"both","billing_class":"facility"},{"gross_charge":843.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC TEND H/F W ROD-PhHOSP","code_information":[{"code":"2811549","type":"CDM"},{"code":"361","type":"RC"},{"code":"26390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.5,"setting":"both","billing_class":"facility"},{"gross_charge":1598.5,"setting":"both","billing_class":"professional"}]},{"description":"REM ROD W INS G H/F-PhHOSP","code_information":[{"code":"2811550","type":"CDM"},{"code":"361","type":"RC"},{"code":"26392","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.25,"setting":"both","billing_class":"facility"},{"gross_charge":1844.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LES MENISCUS/CAP-PhHOSP","code_information":[{"code":"2811551","type":"CDM"},{"code":"361","type":"RC"},{"code":"27347","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.5,"setting":"both","billing_class":"facility"},{"gross_charge":991.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPROSCOPY SPLENECTOMY-PhHOSP","code_information":[{"code":"2811552","type":"CDM"},{"code":"361","type":"RC"},{"code":"38120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2002.5,"setting":"both","billing_class":"facility"},{"gross_charge":2002.5,"setting":"both","billing_class":"professional"}]},{"description":"PERC FIX EP HUM EPCN FX-PhHOSP","code_information":[{"code":"2811553","type":"CDM"},{"code":"361","type":"RC"},{"code":"24566","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.0,"setting":"both","billing_class":"facility"},{"gross_charge":805.0,"setting":"both","billing_class":"professional"}]},{"description":"SURG ECTOPIC PREG ABDL-PhHOSP","code_information":[{"code":"2811555","type":"CDM"},{"code":"361","type":"RC"},{"code":"59130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"facility"},{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"INTRA-ABD OMENTAL FLAP-PhHOSP","code_information":[{"code":"2811556","type":"CDM"},{"code":"361","type":"RC"},{"code":"49905","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.25,"setting":"both","billing_class":"facility"},{"gross_charge":409.25,"setting":"both","billing_class":"professional"}]},{"description":"GASTRCTMY P DIST W/GTJEJN PhHO","code_information":[{"code":"2811557","type":"CDM"},{"code":"361","type":"RC"},{"code":"43632","type":"HCPCS"}],"standard_charges":[{"gross_charge":2349.25,"setting":"both","billing_class":"facility"},{"gross_charge":2349.25,"setting":"both","billing_class":"professional"}]},{"description":"UTERINE E&C HYDA MOLE-PhHOSP","code_information":[{"code":"2811558","type":"CDM"},{"code":"361","type":"RC"},{"code":"59870","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"setting":"both","billing_class":"facility"},{"gross_charge":961.0,"setting":"both","billing_class":"professional"}]},{"description":"PEDICLE FLAP, TRUNK-PhHOSP","code_information":[{"code":"2811559","type":"CDM"},{"code":"361","type":"RC"},{"code":"15570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1382.25,"setting":"both","billing_class":"facility"},{"gross_charge":1382.25,"setting":"both","billing_class":"professional"}]},{"description":"UNLSTD PROC MALE GEN SYS-PhHOS","code_information":[{"code":"2811560","type":"CDM"},{"code":"361","type":"RC"},{"code":"55899","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.75,"setting":"both","billing_class":"facility"},{"gross_charge":289.75,"setting":"both","billing_class":"professional"}]},{"description":"REP BLD VESSEL LWR EXTM-PhHOS","code_information":[{"code":"2811561","type":"CDM"},{"code":"361","type":"RC"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1578.0,"setting":"both","billing_class":"facility"},{"gross_charge":1578.0,"setting":"both","billing_class":"professional"}]},{"description":"REP MU/NU METATARSAL-PhHOSP","code_information":[{"code":"2811562","type":"CDM"},{"code":"361","type":"RC"},{"code":"28322","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"facility"},{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHRSCPY W/LAT RLS-PhHOS","code_information":[{"code":"2811563","type":"CDM"},{"code":"361","type":"RC"},{"code":"29873","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.5,"setting":"both","billing_class":"facility"},{"gross_charge":994.5,"setting":"both","billing_class":"professional"}]},{"description":"FLEX TENDON REP ZONE 2-PhHOSP","code_information":[{"code":"2811564","type":"CDM"},{"code":"361","type":"RC"},{"code":"26356","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.5,"setting":"both","billing_class":"facility"},{"gross_charge":1492.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC MECKELS DIVERTICULUM-PhHOS","code_information":[{"code":"2811565","type":"CDM"},{"code":"361","type":"RC"},{"code":"44800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.75,"setting":"both","billing_class":"facility"},{"gross_charge":1460.75,"setting":"both","billing_class":"professional"}]},{"description":"HUMEROUS CONDYLAR FX TX-PhHOSP","code_information":[{"code":"2811566","type":"CDM"},{"code":"361","type":"RC"},{"code":"24579","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.75,"setting":"both","billing_class":"facility"},{"gross_charge":1566.75,"setting":"both","billing_class":"professional"}]},{"description":"GASTROTOMY,W EXPLORE/REM-PhHOS","code_information":[{"code":"2811567","type":"CDM"},{"code":"361","type":"RC"},{"code":"43500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.25,"setting":"both","billing_class":"facility"},{"gross_charge":1490.25,"setting":"both","billing_class":"professional"}]},{"description":"PERQ NL/PL LITH SMPL<2CM-PhHOS","code_information":[{"code":"2811568","type":"CDM"},{"code":"361","type":"RC"},{"code":"50080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.25,"setting":"both","billing_class":"facility"},{"gross_charge":1329.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE KIDNEY OPEN-PhHOS","code_information":[{"code":"2811569","type":"CDM"},{"code":"361","type":"RC"},{"code":"50220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2013.5,"setting":"both","billing_class":"facility"},{"gross_charge":2013.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE KIDNEY OPEN CMPLX-PhHOS","code_information":[{"code":"2811570","type":"CDM"},{"code":"361","type":"RC"},{"code":"50225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2296.25,"setting":"both","billing_class":"facility"},{"gross_charge":2296.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE KIDNEY OPEN RDCL-PhHOS","code_information":[{"code":"2811571","type":"CDM"},{"code":"361","type":"RC"},{"code":"50230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2434.75,"setting":"both","billing_class":"facility"},{"gross_charge":2434.75,"setting":"both","billing_class":"professional"}]},{"description":"RMVL KIDNEY/URETER SAME-PhHOS","code_information":[{"code":"2811572","type":"CDM"},{"code":"361","type":"RC"},{"code":"50234","type":"HCPCS"}],"standard_charges":[{"gross_charge":2480.75,"setting":"both","billing_class":"facility"},{"gross_charge":2480.75,"setting":"both","billing_class":"professional"}]},{"description":"RMVL KIDNEY/URETER SEPAR-PhHOS","code_information":[{"code":"2811573","type":"CDM"},{"code":"361","type":"RC"},{"code":"50236","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.75,"setting":"both","billing_class":"facility"},{"gross_charge":2783.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REMOVAL KIDNEY-PhHOS","code_information":[{"code":"2811574","type":"CDM"},{"code":"361","type":"RC"},{"code":"50240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.5,"setting":"both","billing_class":"facility"},{"gross_charge":2523.5,"setting":"both","billing_class":"professional"}]},{"description":"DILAT XST TRC NDURLGC PX-PhHOS","code_information":[{"code":"2811575","type":"CDM"},{"code":"361","type":"RC"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.75,"setting":"both","billing_class":"facility"},{"gross_charge":282.75,"setting":"both","billing_class":"professional"}]},{"description":"DILAT XST TRC NEW ACS RCS-PhHO","code_information":[{"code":"2811576","type":"CDM"},{"code":"361","type":"RC"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.25,"setting":"both","billing_class":"facility"},{"gross_charge":470.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP PARTIAL NEPHRECTOMY-PhHOS","code_information":[{"code":"2811577","type":"CDM"},{"code":"361","type":"RC"},{"code":"50543","type":"HCPCS"}],"standard_charges":[{"gross_charge":2831.75,"setting":"both","billing_class":"facility"},{"gross_charge":2831.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY PYELOPLASTY-PhHOS","code_information":[{"code":"2811578","type":"CDM"},{"code":"361","type":"RC"},{"code":"50544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2359.5,"setting":"both","billing_class":"facility"},{"gross_charge":2359.5,"setting":"both","billing_class":"professional"}]},{"description":"LAP RADICAL NEPHRECTOMY-PhHOS","code_information":[{"code":"2811579","type":"CDM"},{"code":"361","type":"RC"},{"code":"50545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.75,"setting":"both","billing_class":"facility"},{"gross_charge":2534.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPIC NEPHRECTOMY-PhHOS","code_information":[{"code":"2811580","type":"CDM"},{"code":"361","type":"RC"},{"code":"50546","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.0,"setting":"both","billing_class":"facility"},{"gross_charge":2292.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO REMOVE W/URETER-PhHOS","code_information":[{"code":"2811581","type":"CDM"},{"code":"361","type":"RC"},{"code":"50548","type":"HCPCS"}],"standard_charges":[{"gross_charge":2548.0,"setting":"both","billing_class":"facility"},{"gross_charge":2548.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPS W/CSTSC&URTRL STENT-PhHOS","code_information":[{"code":"2811582","type":"CDM"},{"code":"361","type":"RC"},{"code":"50947","type":"HCPCS"}],"standard_charges":[{"gross_charge":2679.75,"setting":"both","billing_class":"facility"},{"gross_charge":2679.75,"setting":"both","billing_class":"professional"}]},{"description":"TPRNL BALO CNTNC DEV BI-PhHOS","code_information":[{"code":"2811583","type":"CDM"},{"code":"361","type":"RC"},{"code":"53451","type":"HCPCS"}],"standard_charges":[{"gross_charge":14722.75,"setting":"both","billing_class":"facility"},{"gross_charge":14722.75,"setting":"both","billing_class":"professional"}]},{"description":"TPRNL BALO CNTNC DEV UNI-PhHOS","code_information":[{"code":"2811584","type":"CDM"},{"code":"361","type":"RC"},{"code":"53452","type":"HCPCS"}],"standard_charges":[{"gross_charge":10475.5,"setting":"both","billing_class":"facility"},{"gross_charge":10475.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSC REM ADNEXA BIL-PhHOS","code_information":[{"code":"2811585","type":"CDM"},{"code":"361","type":"RC"},{"code":"58661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1898.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1898.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"IMPL NEUROELECTRODES BIL-PhHOS","code_information":[{"code":"2811586","type":"CDM"},{"code":"361","type":"RC"},{"code":"64561","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":887.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAP RESCT S/INTESTIN ADD-PhHOS","code_information":[{"code":"2811587","type":"CDM"},{"code":"361","type":"RC"},{"code":"44203","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.25,"setting":"both","billing_class":"facility"},{"gross_charge":463.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC/DSTR NTRA-AB 5.1-10CM-PhHO","code_information":[{"code":"2811588","type":"CDM"},{"code":"360","type":"RC"},{"code":"49187","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.25,"setting":"both","billing_class":"facility"},{"gross_charge":1920.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHR SI JT OPN B1GRF-PhHOS","code_information":[{"code":"2811589","type":"CDM"},{"code":"361","type":"RC"},{"code":"27280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"setting":"both","billing_class":"facility"},{"gross_charge":2644.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE/DRAIN EYELID LINE-PhHOS","code_information":[{"code":"2811590","type":"CDM"},{"code":"361","type":"RC"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.25,"setting":"both","billing_class":"facility"},{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC/DST NTRA-AB 10.1-20CM-PhHO","code_information":[{"code":"2811591","type":"CDM"},{"code":"360","type":"RC"},{"code":"49188","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.5,"setting":"both","billing_class":"facility"},{"gross_charge":2293.5,"setting":"both","billing_class":"professional"}]},{"description":"DEEP I&D FOOT INF MULTI-PhHOS","code_information":[{"code":"2811592","type":"CDM"},{"code":"361","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"setting":"both","billing_class":"facility"},{"gross_charge":500.0,"setting":"both","billing_class":"professional"}]},{"description":"DEEP DIS FT INF SGL BURSA-PhHO","code_information":[{"code":"2811593","type":"CDM"},{"code":"361","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.5,"setting":"both","billing_class":"facility"},{"gross_charge":269.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR LEG TENDON EACH-PhHOS","code_information":[{"code":"2811594","type":"CDM"},{"code":"361","type":"RC"},{"code":"27664","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"setting":"both","billing_class":"facility"},{"gross_charge":709.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOGRAPHY XRAY BLADDER-PhHOS","code_information":[{"code":"2811595","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"facility"},{"gross_charge":80.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPSUR PRST8ECT RPBIC RAD-PhHO","code_information":[{"code":"2811596","type":"CDM"},{"code":"360","type":"RC"},{"code":"55866","type":"HCPCS"}],"standard_charges":[{"gross_charge":2275.75,"setting":"both","billing_class":"facility"},{"gross_charge":2275.75,"setting":"both","billing_class":"professional"}]},{"description":"LAP BIL LYMPHADENECTOMY-PhHOS","code_information":[{"code":"2811597","type":"CDM"},{"code":"360","type":"RC"},{"code":"38571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"setting":"both","billing_class":"facility"},{"gross_charge":1267.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL INITIAL HOS CARE-PhHOS","code_information":[{"code":"2811600","type":"CDM"},{"code":"361","type":"RC"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"facility"},{"gross_charge":133.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL INITIAL HOS CARE-PhHOS","code_information":[{"code":"2811601","type":"CDM"},{"code":"361","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL INITIAL HOS CARE-PhHOS","code_information":[{"code":"2811602","type":"CDM"},{"code":"361","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"facility"},{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL SUBSEQ HOS CARE-PhHOS","code_information":[{"code":"2811606","type":"CDM"},{"code":"361","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL SUBSEQ HOS CARE-PhHOS","code_information":[{"code":"2811607","type":"CDM"},{"code":"361","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"facility"},{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL SUBSEQ HOS CARE-PhHOS","code_information":[{"code":"2811608","type":"CDM"},{"code":"361","type":"RC"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OBSV/HOS SAME DAY-PhHO","code_information":[{"code":"2811609","type":"CDM"},{"code":"361","type":"RC"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"facility"},{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OBS/HOS SAME DAY-PhHOS","code_information":[{"code":"2811610","type":"CDM"},{"code":"361","type":"RC"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OBS/HOS SAME DAY-PhHOS","code_information":[{"code":"2811611","type":"CDM"},{"code":"361","type":"RC"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"setting":"both","billing_class":"facility"},{"gross_charge":398.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL HOSP DISCH DAY-PhHOSP","code_information":[{"code":"2811612","type":"CDM"},{"code":"361","type":"RC"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL HOSP DISCH DAY-PhHOSP","code_information":[{"code":"2811613","type":"CDM"},{"code":"361","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"facility"},{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"OP TX HUMERUS SHFT FX-PhHOS","code_information":[{"code":"2811614","type":"CDM"},{"code":"361","type":"RC"},{"code":"24515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.5,"setting":"both","billing_class":"facility"},{"gross_charge":1655.5,"setting":"both","billing_class":"professional"}]},{"description":"INSRT DRUG DEVICE IOP-PhHOS","code_information":[{"code":"2811615","type":"CDM"},{"code":"361","type":"RC"},{"code":"68841","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"BLUE LIGHT CYSTO IMAG AG-PhHOS","code_information":[{"code":"2811616","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9738","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.25,"setting":"both","billing_class":"facility"},{"gross_charge":2509.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOCHR ALLOGRAFT KNEE-PhHOS","code_information":[{"code":"2811617","type":"CDM"},{"code":"361","type":"RC"},{"code":"27415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2589.0,"setting":"both","billing_class":"facility"},{"gross_charge":2589.0,"setting":"both","billing_class":"professional"}]},{"description":"OPEN TX CARPAL SCAPHOID FX-PhH","code_information":[{"code":"2811618","type":"CDM"},{"code":"361","type":"RC"},{"code":"25628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.75,"setting":"both","billing_class":"facility"},{"gross_charge":1353.75,"setting":"both","billing_class":"professional"}]},{"description":"SYNOVIAL BX IP JOINT-PhHOSP","code_information":[{"code":"2811619","type":"CDM"},{"code":"361","type":"RC"},{"code":"26110","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"setting":"both","billing_class":"facility"},{"gross_charge":606.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPS ABL UTERINE FIBROIDS-PhHO","code_information":[{"code":"2811620","type":"CDM"},{"code":"361","type":"RC"},{"code":"58674","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.5,"setting":"both","billing_class":"facility"},{"gross_charge":1545.5,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT OF TIBIA FX-PhHOS","code_information":[{"code":"2811621","type":"CDM"},{"code":"361","type":"RC"},{"code":"27758","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.25,"setting":"both","billing_class":"facility"},{"gross_charge":1686.25,"setting":"both","billing_class":"professional"}]},{"description":"SMOKING CESSATION 3-10M-PhHOS","code_information":[{"code":"2811622","type":"CDM"},{"code":"361","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"facility"},{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"SMOKING CESSATION>10M-PhHOSP","code_information":[{"code":"2811623","type":"CDM"},{"code":"361","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"MANIPULATE WRIST W/ANES-PhHOSP","code_information":[{"code":"2811624","type":"CDM"},{"code":"361","type":"RC"},{"code":"25259","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.75,"setting":"both","billing_class":"facility"},{"gross_charge":793.75,"setting":"both","billing_class":"professional"}]},{"description":"CARPECTOMY,ALL BONES-PhHOSP","code_information":[{"code":"2811625","type":"CDM"},{"code":"361","type":"RC"},{"code":"25215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"setting":"both","billing_class":"facility"},{"gross_charge":1163.0,"setting":"both","billing_class":"professional"}]},{"description":"EXCISE LES CORNEA X/PTER-PhHOS","code_information":[{"code":"2811626","type":"CDM"},{"code":"361","type":"RC"},{"code":"65400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"setting":"both","billing_class":"facility"},{"gross_charge":1267.0,"setting":"both","billing_class":"professional"}]},{"description":"COVER EYE W/MEMBRANE-PhHOSP","code_information":[{"code":"2811627","type":"CDM"},{"code":"361","type":"RC"},{"code":"65778","type":"HCPCS"}],"standard_charges":[{"gross_charge":2598.0,"setting":"both","billing_class":"facility"},{"gross_charge":2598.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTD LAP PROC INTEST-PhHOSP","code_information":[{"code":"2811628","type":"CDM"},{"code":"361","type":"RC"},{"code":"44238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.25,"setting":"both","billing_class":"facility"},{"gross_charge":1996.25,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTD ABD PERITONEUM-PhHOSP","code_information":[{"code":"2811629","type":"CDM"},{"code":"361","type":"RC"},{"code":"49999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.5,"setting":"both","billing_class":"facility"},{"gross_charge":1035.5,"setting":"both","billing_class":"professional"}]},{"description":"MYOMECTOMY VAG METH 1-4 PhHOSP","code_information":[{"code":"2811630","type":"CDM"},{"code":"361","type":"RC"},{"code":"58145","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"setting":"both","billing_class":"facility"},{"gross_charge":1060.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOCHONDRL KNEE AUTOGR-PhHOS","code_information":[{"code":"2811631","type":"CDM"},{"code":"361","type":"RC"},{"code":"27416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.5,"setting":"both","billing_class":"facility"},{"gross_charge":1849.5,"setting":"both","billing_class":"professional"}]},{"description":"ABORTION BY 1 SUPP-PhHOSP","code_information":[{"code":"2811632","type":"CDM"},{"code":"361","type":"RC"},{"code":"59855","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.75,"setting":"both","billing_class":"facility"},{"gross_charge":798.75,"setting":"both","billing_class":"professional"}]},{"description":"MARSUP BARTHOLINS CYST-PhHOS","code_information":[{"code":"2811633","type":"CDM"},{"code":"361","type":"RC"},{"code":"56440","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.75,"setting":"both","billing_class":"facility"},{"gross_charge":342.75,"setting":"both","billing_class":"professional"}]},{"description":"OSTECTOMY FOOT REVISION-PhHOS","code_information":[{"code":"2811634","type":"CDM"},{"code":"360","type":"RC"},{"code":"28116","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.5,"setting":"both","billing_class":"facility"},{"gross_charge":1147.5,"setting":"both","billing_class":"professional"}]},{"description":"ESD ENDO/COLON-OSCOPY-PhHOS","code_information":[{"code":"2811635","type":"CDM"},{"code":"750","type":"RC"},{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"gross_charge":4376.0,"setting":"both","billing_class":"facility"},{"gross_charge":4376.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC, COLON-PhHOS","code_information":[{"code":"2811636","type":"CDM"},{"code":"750","type":"RC"},{"code":"45399","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.75,"setting":"both","billing_class":"facility"},{"gross_charge":995.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC, ESOPHAGUS-PhHOS","code_information":[{"code":"2811637","type":"CDM"},{"code":"750","type":"RC"},{"code":"43499","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.5,"setting":"both","billing_class":"facility"},{"gross_charge":987.5,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOART ALGRFT W/SURF&B1-PhHO","code_information":[{"code":"2811638","type":"CDM"},{"code":"360","type":"RC"},{"code":"20932","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.75,"setting":"both","billing_class":"facility"},{"gross_charge":1462.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PX-URINARY SYS-PhHOS","code_information":[{"code":"2811639","type":"CDM"},{"code":"360","type":"RC"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1988.5,"setting":"both","billing_class":"facility"},{"gross_charge":1988.5,"setting":"both","billing_class":"professional"}]},{"description":"INSRT CATH PLEURA W/IMGE-PhHOS","code_information":[{"code":"2811640","type":"CDM"},{"code":"361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.75,"setting":"both","billing_class":"facility"},{"gross_charge":285.75,"setting":"both","billing_class":"professional"}]},{"description":"DILATION RECTAL NARROWNG-PhHOS","code_information":[{"code":"2811641","type":"CDM"},{"code":"360","type":"RC"},{"code":"45910","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.5,"setting":"both","billing_class":"facility"},{"gross_charge":379.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PX MAT CARE&DLVR-PhHO","code_information":[{"code":"2811642","type":"CDM"},{"code":"720","type":"RC"},{"code":"59899","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.75,"setting":"both","billing_class":"facility"},{"gross_charge":545.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY & DIVERTIC TX-PhHOS","code_information":[{"code":"2811643","type":"CDM"},{"code":"360","type":"RC"},{"code":"52305","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.5,"setting":"both","billing_class":"facility"},{"gross_charge":534.5,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ COMMON DIGIT-PhHOS","code_information":[{"code":"2811644","type":"CDM"},{"code":"360","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"facility"},{"gross_charge":131.75,"setting":"both","billing_class":"professional"}]},{"description":"COR HLX VLGS RSC PRX PHLX-PhHO","code_information":[{"code":"2811645","type":"CDM"},{"code":"360","type":"RC"},{"code":"28292","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"setting":"both","billing_class":"facility"},{"gross_charge":960.0,"setting":"both","billing_class":"professional"}]},{"description":"SUBTALAR ARTHRO W/EXC-PhHOS","code_information":[{"code":"2811646","type":"CDM"},{"code":"360","type":"RC"},{"code":"29905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"setting":"both","billing_class":"facility"},{"gross_charge":1012.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE UTERUS W/CESAREAN-PhHOS","code_information":[{"code":"2811647","type":"CDM"},{"code":"360","type":"RC"},{"code":"59525","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"},{"gross_charge":941.5,"setting":"both","billing_class":"professional"}]},{"description":"REMV/REPLC PENIS PROS CO-PhHOS","code_information":[{"code":"2811648","type":"CDM"},{"code":"360","type":"RC"},{"code":"54411","type":"HCPCS"}],"standard_charges":[{"gross_charge":2002.5,"setting":"both","billing_class":"facility"},{"gross_charge":2002.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPS W/CSTSC&URTRL BIL-PhHOS","code_information":[{"code":"2811649","type":"CDM"},{"code":"360","type":"RC"},{"code":"50947","type":"HCPCS"}],"standard_charges":[{"gross_charge":4019.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":4019.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAPS WO CSTSC&URTRL STNT-PhHOS","code_information":[{"code":"2811650","type":"CDM"},{"code":"360","type":"RC"},{"code":"50948","type":"HCPCS"}],"standard_charges":[{"gross_charge":2457.25,"setting":"both","billing_class":"facility"},{"gross_charge":2457.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPS W/O CSTSC&URTRL BIL-PhHOS","code_information":[{"code":"2811651","type":"CDM"},{"code":"360","type":"RC"},{"code":"50948","type":"HCPCS"}],"standard_charges":[{"gross_charge":3686.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":3686.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DCMPRN FASCT W/O DBRDMT-PhHOS","code_information":[{"code":"2811652","type":"CDM"},{"code":"360","type":"RC"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.75,"setting":"both","billing_class":"facility"},{"gross_charge":1461.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC/DST NTRA-AB 20.1-30CM-PhHO","code_information":[{"code":"2811653","type":"CDM"},{"code":"360","type":"RC"},{"code":"49189","type":"HCPCS"}],"standard_charges":[{"gross_charge":2670.25,"setting":"both","billing_class":"facility"},{"gross_charge":2670.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC/DSTR NTRA-ABD >30 CM-PhHO","code_information":[{"code":"2811654","type":"CDM"},{"code":"360","type":"RC"},{"code":"49190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3292.5,"setting":"both","billing_class":"facility"},{"gross_charge":3292.5,"setting":"both","billing_class":"professional"}]},{"description":"REV BRST RECONSTR BIL-PhHOS","code_information":[{"code":"2811655","type":"CDM"},{"code":"360","type":"RC"},{"code":"19380","type":"HCPCS"}],"standard_charges":[{"gross_charge":2377.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":2377.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"RECONSTRUCT OF NAIL BED-PhHOS","code_information":[{"code":"2811656","type":"CDM"},{"code":"360","type":"RC"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.25,"setting":"both","billing_class":"facility"},{"gross_charge":366.25,"setting":"both","billing_class":"professional"}]},{"description":"EPISIOTOMY/VAGINAL RPR-PhHOS","code_information":[{"code":"2811657","type":"CDM"},{"code":"360","type":"RC"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"facility"},{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"COLNOSCPY W/ENDOSCPC FNB-PhHOS","code_information":[{"code":"2811658","type":"CDM"},{"code":"360","type":"RC"},{"code":"45392","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.5,"setting":"both","billing_class":"facility"},{"gross_charge":584.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPSUR PRST8ECT SMPL STTL-PhHO","code_information":[{"code":"2811659","type":"CDM"},{"code":"360","type":"RC"},{"code":"55867","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.0,"setting":"both","billing_class":"facility"},{"gross_charge":1995.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRP NTRCRPL/MTCRP SSP-PhHOS","code_information":[{"code":"2811660","type":"CDM"},{"code":"360","type":"RC"},{"code":"25448","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"setting":"both","billing_class":"facility"},{"gross_charge":1619.0,"setting":"both","billing_class":"professional"}]},{"description":"ALLOGRFT SPN BONE STRUCT-PhHOS","code_information":[{"code":"2811661","type":"CDM"},{"code":"360","type":"RC"},{"code":"20931","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"setting":"both","billing_class":"facility"},{"gross_charge":232.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT SPN 2-3 FIX DEVICE-PhHO","code_information":[{"code":"2811662","type":"CDM"},{"code":"360","type":"RC"},{"code":"22845","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.0,"setting":"both","billing_class":"facility"},{"gross_charge":1526.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT SPN 4-7 FIX DEVICE-PhHO","code_information":[{"code":"2811663","type":"CDM"},{"code":"360","type":"RC"},{"code":"22846","type":"HCPCS"}],"standard_charges":[{"gross_charge":1588.0,"setting":"both","billing_class":"facility"},{"gross_charge":1588.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE SPN FIXED DEVICE-PhHOS","code_information":[{"code":"2811664","type":"CDM"},{"code":"360","type":"RC"},{"code":"22852","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"setting":"both","billing_class":"facility"},{"gross_charge":1380.0,"setting":"both","billing_class":"professional"}]},{"description":"COMP-ASSIST SPINAL PROC-PhHOS","code_information":[{"code":"2811665","type":"CDM"},{"code":"360","type":"RC"},{"code":"61783","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"setting":"both","billing_class":"facility"},{"gross_charge":443.0,"setting":"both","billing_class":"professional"}]},{"description":"LAM IMPLNT NEUROELECTRODS-PhHO","code_information":[{"code":"2811666","type":"CDM"},{"code":"360","type":"RC"},{"code":"63655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.0,"setting":"both","billing_class":"facility"},{"gross_charge":1798.0,"setting":"both","billing_class":"professional"}]},{"description":"INS/RPLC SPI NPG/RCVR PCK-PhHO","code_information":[{"code":"2811667","type":"CDM"},{"code":"360","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"setting":"both","billing_class":"facility"},{"gross_charge":658.0,"setting":"both","billing_class":"professional"}]},{"description":"ORCHIOPEXY EITH APPR BIL-PhHOS","code_information":[{"code":"2811668","type":"CDM"},{"code":"360","type":"RC"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1239.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TREAT HIP DISLOCATION-PhHOSP","code_information":[{"code":"2811786","type":"CDM"},{"code":"361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.5,"setting":"both","billing_class":"facility"},{"gross_charge":783.5,"setting":"both","billing_class":"professional"}]},{"description":"LACRIMAL PUNCTA SNIP-PhHOSP","code_information":[{"code":"2815428","type":"CDM"},{"code":"361","type":"RC"},{"code":"68440","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"setting":"both","billing_class":"facility"},{"gross_charge":183.75,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ENTROPION SUTURE-PhHOSP","code_information":[{"code":"2815492","type":"CDM"},{"code":"361","type":"RC"},{"code":"67921","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.25,"setting":"both","billing_class":"facility"},{"gross_charge":573.25,"setting":"both","billing_class":"professional"}]},{"description":"LIGAMENT AUGM KNEE INT ART-PhH","code_information":[{"code":"2815614","type":"CDM"},{"code":"361","type":"RC"},{"code":"27428","type":"HCPCS"}],"standard_charges":[{"gross_charge":2101.25,"setting":"both","billing_class":"facility"},{"gross_charge":2101.25,"setting":"both","billing_class":"professional"}]},{"description":"FILLETED FGR/TOE FLAP-PhHOS","code_information":[{"code":"2817004","type":"CDM"},{"code":"361","type":"RC"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.5,"setting":"both","billing_class":"facility"},{"gross_charge":1288.5,"setting":"both","billing_class":"professional"}]},{"description":"WND F/N/HF/G ADL 100SQCM-PhHOS","code_information":[{"code":"2817006","type":"CDM"},{"code":"361","type":"RC"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.5,"setting":"both","billing_class":"facility"},{"gross_charge":228.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX EXISIONAL-PhHOS","code_information":[{"code":"2817008","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.5,"setting":"both","billing_class":"facility"},{"gross_charge":275.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE GRFT; MINOR/SM-PhHOS","code_information":[{"code":"2817010","type":"CDM"},{"code":"361","type":"RC"},{"code":"20900","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"setting":"both","billing_class":"facility"},{"gross_charge":760.0,"setting":"both","billing_class":"professional"}]},{"description":"SPINE BONE AGRFT ADDON-PhHOS","code_information":[{"code":"2817011","type":"CDM"},{"code":"361","type":"RC"},{"code":"20937","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.75,"setting":"both","billing_class":"facility"},{"gross_charge":334.75,"setting":"both","billing_class":"professional"}]},{"description":"SQ ACHILLE TNDN W LCL AN-PhHOS","code_information":[{"code":"2817012","type":"CDM"},{"code":"361","type":"RC"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.75,"setting":"both","billing_class":"facility"},{"gross_charge":641.75,"setting":"both","billing_class":"professional"}]},{"description":"RP SEC ACLES TDN WWO GFT-PhHOS","code_information":[{"code":"2817013","type":"CDM"},{"code":"361","type":"RC"},{"code":"27654","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.5,"setting":"both","billing_class":"facility"},{"gross_charge":1340.5,"setting":"both","billing_class":"professional"}]},{"description":"RP FLX TDN LEG SC WO GRT-PhHOS","code_information":[{"code":"2817014","type":"CDM"},{"code":"361","type":"RC"},{"code":"27659","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.5,"setting":"both","billing_class":"facility"},{"gross_charge":884.5,"setting":"both","billing_class":"professional"}]},{"description":"REL SGL TIB FIB ANK FLEX-PhHOS","code_information":[{"code":"2817015","type":"CDM"},{"code":"361","type":"RC"},{"code":"27680","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.75,"setting":"both","billing_class":"facility"},{"gross_charge":797.75,"setting":"both","billing_class":"professional"}]},{"description":"LEG SHORT TND LEGANK SGL-PhHOS","code_information":[{"code":"2817016","type":"CDM"},{"code":"361","type":"RC"},{"code":"27685","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.5,"setting":"both","billing_class":"facility"},{"gross_charge":1241.5,"setting":"both","billing_class":"professional"}]},{"description":"GASTRONEMIUS RECESSION-PhHOS","code_information":[{"code":"2817017","type":"CDM"},{"code":"361","type":"RC"},{"code":"27687","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"setting":"both","billing_class":"facility"},{"gross_charge":855.0,"setting":"both","billing_class":"professional"}]},{"description":"SUPF TRNF/TRSPL SGL TNDN-PhHOS","code_information":[{"code":"2817018","type":"CDM"},{"code":"361","type":"RC"},{"code":"27690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1201.75,"setting":"both","billing_class":"facility"},{"gross_charge":1201.75,"setting":"both","billing_class":"professional"}]},{"description":"DEP TANSF/TANSL SGLEG TN-PhHOS","code_information":[{"code":"2817019","type":"CDM"},{"code":"361","type":"RC"},{"code":"27691","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.5,"setting":"both","billing_class":"facility"},{"gross_charge":1400.5,"setting":"both","billing_class":"professional"}]},{"description":"REP OF ANKLE LIGAM-PhHOS","code_information":[{"code":"2817020","type":"CDM"},{"code":"361","type":"RC"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"setting":"both","billing_class":"facility"},{"gross_charge":915.0,"setting":"both","billing_class":"professional"}]},{"description":"1 STR RUPT ANK CLTRL LIG-PhHOS","code_information":[{"code":"2817021","type":"CDM"},{"code":"361","type":"RC"},{"code":"27696","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.75,"setting":"both","billing_class":"facility"},{"gross_charge":1050.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROPLTY ANKLE W IMPLT-PhHOS","code_information":[{"code":"2817022","type":"CDM"},{"code":"361","type":"RC"},{"code":"27702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.75,"setting":"both","billing_class":"facility"},{"gross_charge":1819.75,"setting":"both","billing_class":"professional"}]},{"description":"TX OF ANKLE FX-PhHOS","code_information":[{"code":"2817024","type":"CDM"},{"code":"361","type":"RC"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.5,"setting":"both","billing_class":"facility"},{"gross_charge":1444.5,"setting":"both","billing_class":"professional"}]},{"description":"ANK FX W/O FIXJ PST LIP-PhHOS","code_information":[{"code":"2817025","type":"CDM"},{"code":"361","type":"RC"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1631.0,"setting":"both","billing_class":"facility"},{"gross_charge":1631.0,"setting":"both","billing_class":"professional"}]},{"description":"ANKLE FX W/FIXJ PST LIP-PhHOS","code_information":[{"code":"2817026","type":"CDM"},{"code":"361","type":"RC"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.25,"setting":"both","billing_class":"facility"},{"gross_charge":1844.25,"setting":"both","billing_class":"professional"}]},{"description":"FIXATION OF ANKLE JNT-PhHOS","code_information":[{"code":"2817027","type":"CDM"},{"code":"361","type":"RC"},{"code":"27860","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.5,"setting":"both","billing_class":"facility"},{"gross_charge":321.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRODESIS ANKLE OPEN-PhHOS","code_information":[{"code":"2817028","type":"CDM"},{"code":"361","type":"RC"},{"code":"27870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.0,"setting":"both","billing_class":"facility"},{"gross_charge":1926.0,"setting":"both","billing_class":"professional"}]},{"description":"DRN/REM FB IT/MT FT JNT-PhHOS","code_information":[{"code":"2817031","type":"CDM"},{"code":"361","type":"RC"},{"code":"28020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"setting":"both","billing_class":"facility"},{"gross_charge":1012.0,"setting":"both","billing_class":"professional"}]},{"description":"TARSAL TUN RELTIB NERVE-PhHOS","code_information":[{"code":"2817032","type":"CDM"},{"code":"361","type":"RC"},{"code":"28035","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.5,"setting":"both","billing_class":"facility"},{"gross_charge":991.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FT/TOE TUM SC > 1.5CM-PhHOS","code_information":[{"code":"2817033","type":"CDM"},{"code":"361","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.5,"setting":"both","billing_class":"facility"},{"gross_charge":933.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISION OF FOOT LES-PhHOS","code_information":[{"code":"2817034","type":"CDM"},{"code":"361","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.5,"setting":"both","billing_class":"facility"},{"gross_charge":739.5,"setting":"both","billing_class":"professional"}]},{"description":"PART REM FOT PLANTR FASC-PhHOS","code_information":[{"code":"2817035","type":"CDM"},{"code":"361","type":"RC"},{"code":"28060","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.5,"setting":"both","billing_class":"facility"},{"gross_charge":984.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC TRSL/MTATR CYST/TUMR-PhHOS","code_information":[{"code":"2817036","type":"CDM"},{"code":"361","type":"RC"},{"code":"28104","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.75,"setting":"both","billing_class":"facility"},{"gross_charge":996.75,"setting":"both","billing_class":"professional"}]},{"description":"COMPL EXC OTH METRSL HED-PhHOS","code_information":[{"code":"2817037","type":"CDM"},{"code":"361","type":"RC"},{"code":"28112","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.25,"setting":"both","billing_class":"facility"},{"gross_charge":919.25,"setting":"both","billing_class":"professional"}]},{"description":"COMPL EXC 5TH METRSL HED-PhHOS","code_information":[{"code":"2817038","type":"CDM"},{"code":"361","type":"RC"},{"code":"28113","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.75,"setting":"both","billing_class":"facility"},{"gross_charge":1105.75,"setting":"both","billing_class":"professional"}]},{"description":"PART REM OF ANKLE/HEEL-PhHOS","code_information":[{"code":"2817039","type":"CDM"},{"code":"361","type":"RC"},{"code":"28120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"setting":"both","billing_class":"facility"},{"gross_charge":1275.0,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF FOOT BONE-PhHOS","code_information":[{"code":"2817040","type":"CDM"},{"code":"361","type":"RC"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"setting":"both","billing_class":"facility"},{"gross_charge":1121.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE METATARSAL-PhHOS","code_information":[{"code":"2817041","type":"CDM"},{"code":"361","type":"RC"},{"code":"28140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.75,"setting":"both","billing_class":"facility"},{"gross_charge":1108.75,"setting":"both","billing_class":"professional"}]},{"description":"REP OF FOOT TEND-PhHOS","code_information":[{"code":"2817042","type":"CDM"},{"code":"361","type":"RC"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"setting":"both","billing_class":"facility"},{"gross_charge":908.0,"setting":"both","billing_class":"professional"}]},{"description":"ADV PST TIB TNDN W EXC-PhHOS","code_information":[{"code":"2817043","type":"CDM"},{"code":"361","type":"RC"},{"code":"28238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","billing_class":"facility"},{"gross_charge":1253.75,"setting":"both","billing_class":"professional"}]},{"description":"MTP JNT CAPMY EA SGL JNT-PhHOS","code_information":[{"code":"2817044","type":"CDM"},{"code":"361","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.25,"setting":"both","billing_class":"facility"},{"gross_charge":928.25,"setting":"both","billing_class":"professional"}]},{"description":"TOE WEBBING OP-PhHOS","code_information":[{"code":"2817045","type":"CDM"},{"code":"361","type":"RC"},{"code":"28280","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"setting":"both","billing_class":"facility"},{"gross_charge":968.0,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REM OF FOOT BONE-PhHOS","code_information":[{"code":"2817047","type":"CDM"},{"code":"361","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.5,"setting":"both","billing_class":"facility"},{"gross_charge":1146.5,"setting":"both","billing_class":"professional"}]},{"description":"CORRJ HALUX RIGD W/IMPLT-PhHOS","code_information":[{"code":"2817048","type":"CDM"},{"code":"361","type":"RC"},{"code":"28291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1375.0,"setting":"both","billing_class":"facility"},{"gross_charge":1375.0,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION OF BUNION-PhHOS","code_information":[{"code":"2817049","type":"CDM"},{"code":"361","type":"RC"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.5,"setting":"both","billing_class":"facility"},{"gross_charge":1708.5,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION HALLUX VALGUS-PhHOS","code_information":[{"code":"2817050","type":"CDM"},{"code":"361","type":"RC"},{"code":"28297","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.0,"setting":"both","billing_class":"facility"},{"gross_charge":1977.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOTOMY; CALCANEUS-PhHOS","code_information":[{"code":"2817051","type":"CDM"},{"code":"361","type":"RC"},{"code":"28300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1226.25,"setting":"both","billing_class":"facility"},{"gross_charge":1226.25,"setting":"both","billing_class":"professional"}]},{"description":"MT SHORTEN NOT 1ST MT-PhHOS","code_information":[{"code":"2817052","type":"CDM"},{"code":"361","type":"RC"},{"code":"28308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.25,"setting":"both","billing_class":"facility"},{"gross_charge":1073.25,"setting":"both","billing_class":"professional"}]},{"description":"SHOTN PROX PLYNX 1ST TOE-PhHOS","code_information":[{"code":"2817053","type":"CDM"},{"code":"361","type":"RC"},{"code":"28310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.25,"setting":"both","billing_class":"facility"},{"gross_charge":1030.25,"setting":"both","billing_class":"professional"}]},{"description":"RECONS ANGL TOE DEFOR ST-PhHOS","code_information":[{"code":"2817054","type":"CDM"},{"code":"361","type":"RC"},{"code":"28313","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.5,"setting":"both","billing_class":"facility"},{"gross_charge":987.5,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSAL FX-PhHOS","code_information":[{"code":"2817055","type":"CDM"},{"code":"361","type":"RC"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.5,"setting":"both","billing_class":"facility"},{"gross_charge":1037.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FOOT DISLOC-PhHOS","code_information":[{"code":"2817056","type":"CDM"},{"code":"361","type":"RC"},{"code":"28606","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.5,"setting":"both","billing_class":"facility"},{"gross_charge":730.5,"setting":"both","billing_class":"professional"}]},{"description":"RP TARSOMTTRSL JNT DISL-PhHOS","code_information":[{"code":"2817057","type":"CDM"},{"code":"361","type":"RC"},{"code":"28615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.0,"setting":"both","billing_class":"facility"},{"gross_charge":1529.0,"setting":"both","billing_class":"professional"}]},{"description":"TRIPLE ARTHRODESIS-PhHOS","code_information":[{"code":"2817058","type":"CDM"},{"code":"361","type":"RC"},{"code":"28715","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.75,"setting":"both","billing_class":"facility"},{"gross_charge":1769.75,"setting":"both","billing_class":"professional"}]},{"description":"SUBTALAR ARTHRODESIS-PhHOS","code_information":[{"code":"2817059","type":"CDM"},{"code":"361","type":"RC"},{"code":"28725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"setting":"both","billing_class":"facility"},{"gross_charge":1467.0,"setting":"both","billing_class":"professional"}]},{"description":"ARHROD MT/TMT MULT/TRANV-PhHOS","code_information":[{"code":"2817060","type":"CDM"},{"code":"361","type":"RC"},{"code":"28730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.25,"setting":"both","billing_class":"facility"},{"gross_charge":1384.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHDESIS MT/TME SGL JNT-PhHOS","code_information":[{"code":"2817061","type":"CDM"},{"code":"361","type":"RC"},{"code":"28740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.0,"setting":"both","billing_class":"facility"},{"gross_charge":1580.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHDESIS GRT TO MTP JNT-PhHOS","code_information":[{"code":"2817062","type":"CDM"},{"code":"361","type":"RC"},{"code":"28750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.5,"setting":"both","billing_class":"facility"},{"gross_charge":1500.5,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE FOOT; MIDTARSAL-PhHOS","code_information":[{"code":"2817063","type":"CDM"},{"code":"361","type":"RC"},{"code":"28800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.75,"setting":"both","billing_class":"facility"},{"gross_charge":1006.75,"setting":"both","billing_class":"professional"}]},{"description":"AMPUT FOOT TRANSMETATRSL-PhHOS","code_information":[{"code":"2817064","type":"CDM"},{"code":"361","type":"RC"},{"code":"28805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.75,"setting":"both","billing_class":"facility"},{"gross_charge":1361.75,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE TOE & METATAR-PhHOS","code_information":[{"code":"2817065","type":"CDM"},{"code":"361","type":"RC"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"setting":"both","billing_class":"facility"},{"gross_charge":808.0,"setting":"both","billing_class":"professional"}]},{"description":"AMPUTATE TOE-PhHOS","code_information":[{"code":"2817066","type":"CDM"},{"code":"361","type":"RC"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.75,"setting":"both","billing_class":"facility"},{"gross_charge":1051.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PROC FOOT TOES-PhHOS","code_information":[{"code":"2817067","type":"CDM"},{"code":"361","type":"RC"},{"code":"28899","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.25,"setting":"both","billing_class":"facility"},{"gross_charge":467.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY RIGD TOTL  LEG CST-PhHOS","code_information":[{"code":"2817068","type":"CDM"},{"code":"361","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRS ANKL EXC OSCN DEF-PhHOS","code_information":[{"code":"2817069","type":"CDM"},{"code":"361","type":"RC"},{"code":"29891","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.75,"setting":"both","billing_class":"facility"},{"gross_charge":1260.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHSCY ANKL EXT DBRIDEM-PhHOS","code_information":[{"code":"2817070","type":"CDM"},{"code":"361","type":"RC"},{"code":"29898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"setting":"both","billing_class":"facility"},{"gross_charge":1118.0,"setting":"both","billing_class":"professional"}]},{"description":"ANKLE ARTHROSCY W FUSION-PhHOS","code_information":[{"code":"2817071","type":"CDM"},{"code":"361","type":"RC"},{"code":"29899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.25,"setting":"both","billing_class":"facility"},{"gross_charge":1943.25,"setting":"both","billing_class":"professional"}]},{"description":"LIGATE/DIVIDE/EXISE VEIN-PhHOS","code_information":[{"code":"2817072","type":"CDM"},{"code":"361","type":"RC"},{"code":"37785","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","billing_class":"facility"},{"gross_charge":666.25,"setting":"both","billing_class":"professional"}]},{"description":"REVISE FING/TOE NRVE 1-2-PhHOS","code_information":[{"code":"2817073","type":"CDM"},{"code":"361","type":"RC"},{"code":"64702","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.75,"setting":"both","billing_class":"facility"},{"gross_charge":945.75,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPLTY NRVE HND OR FT-PhHOS","code_information":[{"code":"2817074","type":"CDM"},{"code":"361","type":"RC"},{"code":"64704","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"setting":"both","billing_class":"facility"},{"gross_charge":605.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPL NRV ARM/LEG-PhHOSP","code_information":[{"code":"2817075","type":"CDM"},{"code":"361","type":"RC"},{"code":"64708","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.75,"setting":"both","billing_class":"facility"},{"gross_charge":947.75,"setting":"both","billing_class":"professional"}]},{"description":"NERVE DECOMPRESSION-PhHOS","code_information":[{"code":"2817076","type":"CDM"},{"code":"361","type":"RC"},{"code":"64722","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.5,"setting":"both","billing_class":"facility"},{"gross_charge":676.5,"setting":"both","billing_class":"professional"}]},{"description":"NRV RPR W/NRV ALGRFT 1ST-PhHOS","code_information":[{"code":"2817077","type":"CDM"},{"code":"361","type":"RC"},{"code":"64912","type":"HCPCS"}],"standard_charges":[{"gross_charge":1719.75,"setting":"both","billing_class":"facility"},{"gross_charge":1719.75,"setting":"both","billing_class":"professional"}]},{"description":"MICROSURG ADD-ON-PhHOS","code_information":[{"code":"2817078","type":"CDM"},{"code":"361","type":"RC"},{"code":"69990","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","billing_class":"facility"},{"gross_charge":433.5,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX < 50CM-PhHOS","code_information":[{"code":"2817079","type":"CDM"},{"code":"361","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"facility"},{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"REM CORNL EPI W/WO CHMCA-PhHOS","code_information":[{"code":"2817080","type":"CDM"},{"code":"361","type":"RC"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"facility"},{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"TENTMY OP FLEXR TOE SNG-PhHOS","code_information":[{"code":"2817081","type":"CDM"},{"code":"361","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"setting":"both","billing_class":"facility"},{"gross_charge":1656.0,"setting":"both","billing_class":"professional"}]},{"description":"INC MULTI SQ TOE TENDONS-PhHOS","code_information":[{"code":"2817082","type":"CDM"},{"code":"361","type":"RC"},{"code":"28011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"setting":"both","billing_class":"facility"},{"gross_charge":1656.0,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN SINGLE LES-PhHOSP","code_information":[{"code":"2817083","type":"CDM"},{"code":"361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"INCL BX SKN EA SEP/ADDL-PhHOSP","code_information":[{"code":"2817084","type":"CDM"},{"code":"361","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.25,"setting":"both","billing_class":"facility"},{"gross_charge":31.25,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY NAIL UNIT-PhHOSP","code_information":[{"code":"2817085","type":"CDM"},{"code":"361","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 1.1-2.5 CM-PhHOSP","code_information":[{"code":"2817086","type":"CDM"},{"code":"361","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"setting":"both","billing_class":"facility"},{"gross_charge":278.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L ADDL 5CM/<-PhHOSP","code_information":[{"code":"2817087","type":"CDM"},{"code":"361","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.25,"setting":"both","billing_class":"facility"},{"gross_charge":138.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN PINCH GRAFT-PhHOSP","code_information":[{"code":"2817088","type":"CDM"},{"code":"361","type":"RC"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.5,"setting":"both","billing_class":"facility"},{"gross_charge":458.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-PhHOSP","code_information":[{"code":"2817089","type":"CDM"},{"code":"361","type":"RC"},{"code":"15241","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"facility"},{"gross_charge":107.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-PhHOSP","code_information":[{"code":"2817090","type":"CDM"},{"code":"361","type":"RC"},{"code":"15261","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.75,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ MAL LES 0.5CM/<-PhHOS","code_information":[{"code":"2817091","type":"CDM"},{"code":"361","type":"RC"},{"code":"17270","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"facility"},{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTOF SKIN LESIONS-PhHOSP","code_information":[{"code":"2817092","type":"CDM"},{"code":"361","type":"RC"},{"code":"17276","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.5,"setting":"both","billing_class":"facility"},{"gross_charge":200.5,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE H/N/HF/G-PhHOSP","code_information":[{"code":"2817093","type":"CDM"},{"code":"361","type":"RC"},{"code":"17311","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"setting":"both","billing_class":"facility"},{"gross_charge":357.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE-PhHOSP","code_information":[{"code":"2817094","type":"CDM"},{"code":"361","type":"RC"},{"code":"17312","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"facility"},{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE T/A/L-PhHOSP","code_information":[{"code":"2817095","type":"CDM"},{"code":"361","type":"RC"},{"code":"17313","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"setting":"both","billing_class":"facility"},{"gross_charge":320.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE T/A/L-PhHOSP","code_information":[{"code":"2817096","type":"CDM"},{"code":"361","type":"RC"},{"code":"17314","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"setting":"both","billing_class":"facility"},{"gross_charge":176.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS SURG ADDL BLOCK-PhHOSP","code_information":[{"code":"2817097","type":"CDM"},{"code":"361","type":"RC"},{"code":"17315","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.5,"setting":"both","billing_class":"facility"},{"gross_charge":50.5,"setting":"both","billing_class":"professional"}]},{"description":"TESTICULAR PROSTHESIS-PhHOS","code_information":[{"code":"2817110","type":"CDM"},{"code":"361","type":"RC"},{"code":"54660","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"setting":"both","billing_class":"facility"},{"gross_charge":733.0,"setting":"both","billing_class":"professional"}]},{"description":"ECHO TRNESPHAGEL INTRAOP-PhHOS","code_information":[{"code":"2817111","type":"CDM"},{"code":"361","type":"RC"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.75,"setting":"both","billing_class":"facility"},{"gross_charge":190.75,"setting":"both","billing_class":"professional"}]},{"description":"MOD SED SAME PHYS INIT-PhHOS","code_information":[{"code":"2817112","type":"CDM"},{"code":"361","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"facility"},{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"MOD SED SAME PHYS EA AD-PhHOS","code_information":[{"code":"2817113","type":"CDM"},{"code":"361","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"TRNSAB ESO HIAT HERN RPR-PhHOS","code_information":[{"code":"2817114","type":"CDM"},{"code":"361","type":"RC"},{"code":"43332","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH HIAT HERN W/IMP-PhHOS","code_information":[{"code":"2817115","type":"CDM"},{"code":"361","type":"RC"},{"code":"43333","type":"HCPCS"}],"standard_charges":[{"gross_charge":2373.75,"setting":"both","billing_class":"facility"},{"gross_charge":2373.75,"setting":"both","billing_class":"professional"}]},{"description":"TRANSTHOR DIAH HERN RPR-PhHOS","code_information":[{"code":"2817116","type":"CDM"},{"code":"361","type":"RC"},{"code":"43334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2334.0,"setting":"both","billing_class":"facility"},{"gross_charge":2334.0,"setting":"both","billing_class":"professional"}]},{"description":"TRNSTHOR DIAPH HERN RPR-PhHOS","code_information":[{"code":"2817117","type":"CDM"},{"code":"361","type":"RC"},{"code":"43335","type":"HCPCS"}],"standard_charges":[{"gross_charge":2495.0,"setting":"both","billing_class":"facility"},{"gross_charge":2495.0,"setting":"both","billing_class":"professional"}]},{"description":"THORABD DIAPHR HERN RPR-PhHOS","code_information":[{"code":"2817118","type":"CDM"},{"code":"361","type":"RC"},{"code":"43336","type":"HCPCS"}],"standard_charges":[{"gross_charge":2711.25,"setting":"both","billing_class":"facility"},{"gross_charge":2711.25,"setting":"both","billing_class":"professional"}]},{"description":"THORABD DIAPHR HERN RRP-PhHOS","code_information":[{"code":"2817119","type":"CDM"},{"code":"361","type":"RC"},{"code":"43337","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.75,"setting":"both","billing_class":"facility"},{"gross_charge":2888.75,"setting":"both","billing_class":"professional"}]},{"description":"THOROSCOPY W/PLEURODESIS-PhHOS","code_information":[{"code":"2817120","type":"CDM"},{"code":"361","type":"RC"},{"code":"32650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.5,"setting":"both","billing_class":"facility"},{"gross_charge":1243.5,"setting":"both","billing_class":"professional"}]},{"description":"THORASCOPY RESECT BULLAE-PhHOS","code_information":[{"code":"2817121","type":"CDM"},{"code":"361","type":"RC"},{"code":"32655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1784.0,"setting":"both","billing_class":"facility"},{"gross_charge":1784.0,"setting":"both","billing_class":"professional"}]},{"description":"BX LOWER LEG SOFT TISSUE-PhHOS","code_information":[{"code":"2817122","type":"CDM"},{"code":"361","type":"RC"},{"code":"27613","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.5,"setting":"both","billing_class":"facility"},{"gross_charge":480.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTP LEVEL 4 NEW-PhHOS","code_information":[{"code":"2817124","type":"CDM"},{"code":"361","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"setting":"both","billing_class":"facility"},{"gross_charge":203.0,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING UNNA BOOT BIL-PhHOS","code_information":[{"code":"2817125","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":142.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BLEPHAROPLASTY UP LID-PhHOS","code_information":[{"code":"2817126","type":"CDM"},{"code":"361","type":"RC"},{"code":"15822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1921.0,"setting":"both","billing_class":"facility"},{"gross_charge":1921.0,"setting":"both","billing_class":"professional"}]},{"description":"REVISIO GASTOJEJUNOSTOMY PhHOS","code_information":[{"code":"2817127","type":"CDM"},{"code":"361","type":"RC"},{"code":"43860","type":"HCPCS"}],"standard_charges":[{"gross_charge":3690.5,"setting":"both","billing_class":"facility"},{"gross_charge":3690.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGOSCOPY US-PhHOS","code_information":[{"code":"2817128","type":"CDM"},{"code":"361","type":"RC"},{"code":"43231","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"facility"},{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH W/US NEEDLE BX-PhHOS","code_information":[{"code":"2817129","type":"CDM"},{"code":"361","type":"RC"},{"code":"43232","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.25,"setting":"both","billing_class":"facility"},{"gross_charge":369.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOSCOPIC US EXAM ESOPH-PhHOS","code_information":[{"code":"2817130","type":"CDM"},{"code":"361","type":"RC"},{"code":"43237","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.25,"setting":"both","billing_class":"facility"},{"gross_charge":363.25,"setting":"both","billing_class":"professional"}]},{"description":"EGD US FINE NDL BX/ASPIR-PhHOS","code_information":[{"code":"2817131","type":"CDM"},{"code":"361","type":"RC"},{"code":"43238","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.5,"setting":"both","billing_class":"facility"},{"gross_charge":431.5,"setting":"both","billing_class":"professional"}]},{"description":"EGD US FNA/BX ALTERED-PhHOS","code_information":[{"code":"2817132","type":"CDM"},{"code":"361","type":"RC"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.75,"setting":"both","billing_class":"facility"},{"gross_charge":486.75,"setting":"both","billing_class":"professional"}]},{"description":"EGD US TRNMRL INJXN/MARK-PhHOS","code_information":[{"code":"2817133","type":"CDM"},{"code":"361","type":"RC"},{"code":"43253","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.75,"setting":"both","billing_class":"facility"},{"gross_charge":486.75,"setting":"both","billing_class":"professional"}]},{"description":"ERCP SPHINCTER PRES MEAS-PhHOS","code_information":[{"code":"2817134","type":"CDM"},{"code":"361","type":"RC"},{"code":"43263","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"setting":"both","billing_class":"facility"},{"gross_charge":662.0,"setting":"both","billing_class":"professional"}]},{"description":"ERCP LITHOTRIPSY CALCULI-PhHOS","code_information":[{"code":"2817135","type":"CDM"},{"code":"361","type":"RC"},{"code":"43265","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"setting":"both","billing_class":"facility"},{"gross_charge":804.0,"setting":"both","billing_class":"professional"}]},{"description":"ERCP DUCT STENT PLACMENT-PhHOS","code_information":[{"code":"2817136","type":"CDM"},{"code":"361","type":"RC"},{"code":"43274","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"setting":"both","billing_class":"facility"},{"gross_charge":859.0,"setting":"both","billing_class":"professional"}]},{"description":"ERCP REM FORGN BODY DUCT-PhHOS","code_information":[{"code":"2817137","type":"CDM"},{"code":"361","type":"RC"},{"code":"43275","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.75,"setting":"both","billing_class":"facility"},{"gross_charge":697.75,"setting":"both","billing_class":"professional"}]},{"description":"ERCP STENT EX W/DILATE-PhHOS","code_information":[{"code":"2817138","type":"CDM"},{"code":"361","type":"RC"},{"code":"43276","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.75,"setting":"both","billing_class":"facility"},{"gross_charge":893.75,"setting":"both","billing_class":"professional"}]},{"description":"ERCP EA DUCT/AMP DILATE-PhHOS","code_information":[{"code":"2817139","type":"CDM"},{"code":"361","type":"RC"},{"code":"43277","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"setting":"both","billing_class":"facility"},{"gross_charge":702.0,"setting":"both","billing_class":"professional"}]},{"description":"ERCP LESION ABL W/DILATE-PhHOS","code_information":[{"code":"2817140","type":"CDM"},{"code":"361","type":"RC"},{"code":"43278","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.75,"setting":"both","billing_class":"facility"},{"gross_charge":801.75,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSCOPY W/ULTRASOUND-PhHOS","code_information":[{"code":"2817141","type":"CDM"},{"code":"361","type":"RC"},{"code":"44406","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.5,"setting":"both","billing_class":"facility"},{"gross_charge":425.5,"setting":"both","billing_class":"professional"}]},{"description":"SIGMOIDOSCOPY W/ULTRASND-PhHOS","code_information":[{"code":"2817142","type":"CDM"},{"code":"361","type":"RC"},{"code":"45341","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.5,"setting":"both","billing_class":"facility"},{"gross_charge":229.5,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSCOPY W/RESECTION-PhHOS","code_information":[{"code":"2817143","type":"CDM"},{"code":"361","type":"RC"},{"code":"45390","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.25,"setting":"both","billing_class":"facility"},{"gross_charge":616.25,"setting":"both","billing_class":"professional"}]},{"description":"COLONOSCOPY W/ENDOSCP US-PhHOS","code_information":[{"code":"2817144","type":"CDM"},{"code":"361","type":"RC"},{"code":"45391","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"facility"},{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"SPINE BONE ALGRFT ADD-PhHOS","code_information":[{"code":"2817145","type":"CDM"},{"code":"361","type":"RC"},{"code":"20930","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"setting":"both","billing_class":"facility"},{"gross_charge":175.5,"setting":"both","billing_class":"professional"}]},{"description":"SPINE BONE AGRFT ADD-PhHOS","code_information":[{"code":"2817146","type":"CDM"},{"code":"361","type":"RC"},{"code":"20936","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.75,"setting":"both","billing_class":"facility"},{"gross_charge":236.75,"setting":"both","billing_class":"professional"}]},{"description":"NECK SPNE FUS&REM BEL C2-PhHOS","code_information":[{"code":"2817147","type":"CDM"},{"code":"361","type":"RC"},{"code":"22551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3201.0,"setting":"both","billing_class":"facility"},{"gross_charge":3201.0,"setting":"both","billing_class":"professional"}]},{"description":"ADDL NECK SPINE FUSION-PhHOS","code_information":[{"code":"2817148","type":"CDM"},{"code":"361","type":"RC"},{"code":"22552","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"setting":"both","billing_class":"facility"},{"gross_charge":680.0,"setting":"both","billing_class":"professional"}]},{"description":"NECK SPINE FUSION-PhHOS","code_information":[{"code":"2817149","type":"CDM"},{"code":"361","type":"RC"},{"code":"22600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2412.5,"setting":"both","billing_class":"facility"},{"gross_charge":2412.5,"setting":"both","billing_class":"professional"}]},{"description":"LUMBAR SPINE FUSION-PhHOS","code_information":[{"code":"2817150","type":"CDM"},{"code":"361","type":"RC"},{"code":"22612","type":"HCPCS"}],"standard_charges":[{"gross_charge":3220.25,"setting":"both","billing_class":"facility"},{"gross_charge":3220.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINE FUSN EXTRA SEGMENT-PhHOS","code_information":[{"code":"2817151","type":"CDM"},{"code":"361","type":"RC"},{"code":"22614","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.75,"setting":"both","billing_class":"facility"},{"gross_charge":791.75,"setting":"both","billing_class":"professional"}]},{"description":"LUMBAR SPINE FUS COMBIND-PhHOS","code_information":[{"code":"2817152","type":"CDM"},{"code":"361","type":"RC"},{"code":"22633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3479.25,"setting":"both","billing_class":"facility"},{"gross_charge":3479.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINE FUSN EXTRA SEGMENT-PhHOS","code_information":[{"code":"2817153","type":"CDM"},{"code":"361","type":"RC"},{"code":"22634","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.25,"setting":"both","billing_class":"facility"},{"gross_charge":929.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT SPINE FIXN DEVICE-PhHOS","code_information":[{"code":"2817154","type":"CDM"},{"code":"361","type":"RC"},{"code":"22840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1535.25,"setting":"both","billing_class":"facility"},{"gross_charge":1535.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT SPINE FIX DEVICE-PhHOS","code_information":[{"code":"2817155","type":"CDM"},{"code":"361","type":"RC"},{"code":"22842","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.25,"setting":"both","billing_class":"facility"},{"gross_charge":1542.25,"setting":"both","billing_class":"professional"}]},{"description":"INSJ BIOMECHANICAL DEVCE-PhHOS","code_information":[{"code":"2817156","type":"CDM"},{"code":"361","type":"RC"},{"code":"22853","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.5,"setting":"both","billing_class":"facility"},{"gross_charge":484.5,"setting":"both","billing_class":"professional"}]},{"description":"INSJ BIOMECHANICAL DEV-PhHOS","code_information":[{"code":"2817157","type":"CDM"},{"code":"361","type":"RC"},{"code":"22854","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.5,"setting":"both","billing_class":"facility"},{"gross_charge":627.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHRODIS SACROILIAC JNT-PhHOS","code_information":[{"code":"2817158","type":"CDM"},{"code":"361","type":"RC"},{"code":"27279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"setting":"both","billing_class":"facility"},{"gross_charge":1622.0,"setting":"both","billing_class":"professional"}]},{"description":"LOW BACK DISK SURGERY-PhHOS","code_information":[{"code":"2817159","type":"CDM"},{"code":"361","type":"RC"},{"code":"63030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2547.0,"setting":"both","billing_class":"facility"},{"gross_charge":2547.0,"setting":"both","billing_class":"professional"}]},{"description":"REM SPINE LAMINA 1 LMBR-PhHOS","code_information":[{"code":"2817160","type":"CDM"},{"code":"361","type":"RC"},{"code":"63047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2245.25,"setting":"both","billing_class":"facility"},{"gross_charge":2245.25,"setting":"both","billing_class":"professional"}]},{"description":"REM SPINAL LAMINA ADD-ON-PhHOS","code_information":[{"code":"2817161","type":"CDM"},{"code":"361","type":"RC"},{"code":"63048","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.5,"setting":"both","billing_class":"facility"},{"gross_charge":427.5,"setting":"both","billing_class":"professional"}]},{"description":"MICROSURGERY ADD-ON-PhHOS","code_information":[{"code":"2817162","type":"CDM"},{"code":"361","type":"RC"},{"code":"69990","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.75,"setting":"both","billing_class":"facility"},{"gross_charge":439.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN OUTER EAR CANL LES-PhHOS","code_information":[{"code":"2817163","type":"CDM"},{"code":"361","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"setting":"both","billing_class":"facility"},{"gross_charge":447.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE/DRAIN TEAR SAC-PhHOS","code_information":[{"code":"2817164","type":"CDM"},{"code":"361","type":"RC"},{"code":"68420","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.75,"setting":"both","billing_class":"facility"},{"gross_charge":638.75,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LINING LESION-PhHOS","code_information":[{"code":"2817165","type":"CDM"},{"code":"361","type":"RC"},{"code":"68110","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"setting":"both","billing_class":"facility"},{"gross_charge":449.0,"setting":"both","billing_class":"professional"}]},{"description":"HRHC LIG 1 HROID W/O IMG-PhHOS","code_information":[{"code":"2817166","type":"CDM"},{"code":"361","type":"RC"},{"code":"46945","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.75,"setting":"both","billing_class":"facility"},{"gross_charge":641.75,"setting":"both","billing_class":"professional"}]},{"description":"PART REMOVAL LEG BONE(S)-PhHOS","code_information":[{"code":"2817167","type":"CDM"},{"code":"361","type":"RC"},{"code":"27360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1691.25,"setting":"both","billing_class":"facility"},{"gross_charge":1691.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF URETHRA INJURY-PhHOS","code_information":[{"code":"2817168","type":"CDM"},{"code":"361","type":"RC"},{"code":"53502","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.75,"setting":"both","billing_class":"facility"},{"gross_charge":904.75,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF FOOT TENDON-PhHOS","code_information":[{"code":"2817169","type":"CDM"},{"code":"361","type":"RC"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.5,"setting":"both","billing_class":"facility"},{"gross_charge":936.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF TOE DISLOCTION-PhHOS","code_information":[{"code":"2817170","type":"CDM"},{"code":"361","type":"RC"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"facility"},{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROTOMY DRAIN ABSC-PhHOS","code_information":[{"code":"2817171","type":"CDM"},{"code":"361","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"},{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL VITREOUS PARTIAL-PhHOS","code_information":[{"code":"2817172","type":"CDM"},{"code":"361","type":"RC"},{"code":"67005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.25,"setting":"both","billing_class":"facility"},{"gross_charge":1846.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LES PTERYGIUM W/GRFT-PhHOS","code_information":[{"code":"2817173","type":"CDM"},{"code":"361","type":"RC"},{"code":"65426","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.5,"setting":"both","billing_class":"facility"},{"gross_charge":1806.5,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE REP BLADDER COMP-PhHOS","code_information":[{"code":"2817174","type":"CDM"},{"code":"361","type":"RC"},{"code":"51865","type":"HCPCS"}],"standard_charges":[{"gross_charge":3397.75,"setting":"both","billing_class":"facility"},{"gross_charge":3397.75,"setting":"both","billing_class":"professional"}]},{"description":"LASER SURGERY PROSTATE-PhHOS","code_information":[{"code":"2817175","type":"CDM"},{"code":"361","type":"RC"},{"code":"52647","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"setting":"both","billing_class":"facility"},{"gross_charge":1220.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-MYOMECTOMY COMPLX-PhHOS","code_information":[{"code":"2817176","type":"CDM"},{"code":"361","type":"RC"},{"code":"58546","type":"HCPCS"}],"standard_charges":[{"gross_charge":2097.25,"setting":"both","billing_class":"facility"},{"gross_charge":2097.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF GUM LESION-PhHOS","code_information":[{"code":"2817177","type":"CDM"},{"code":"361","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.5,"setting":"both","billing_class":"facility"},{"gross_charge":577.5,"setting":"both","billing_class":"professional"}]},{"description":"EGD US DUODENUM-JEJUNUM-PhHOS","code_information":[{"code":"2817178","type":"CDM"},{"code":"361","type":"RC"},{"code":"43259","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.5,"setting":"both","billing_class":"facility"},{"gross_charge":426.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC VARI/LIG SPER VN ABD-PhHOS","code_information":[{"code":"2817179","type":"CDM"},{"code":"361","type":"RC"},{"code":"55535","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"setting":"both","billing_class":"facility"},{"gross_charge":810.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT LENS PROSTHESIS-PhHOS","code_information":[{"code":"2817180","type":"CDM"},{"code":"361","type":"RC"},{"code":"66985","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"setting":"both","billing_class":"facility"},{"gross_charge":1418.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPROSCOPY SALPINGOSTOMY-PhHOS","code_information":[{"code":"2817181","type":"CDM"},{"code":"361","type":"RC"},{"code":"58673","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.5,"setting":"both","billing_class":"facility"},{"gross_charge":1495.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE SHOULDER FOR BODY-PhHOS","code_information":[{"code":"2817182","type":"CDM"},{"code":"361","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.25,"setting":"both","billing_class":"facility"},{"gross_charge":573.25,"setting":"both","billing_class":"professional"}]},{"description":"INT HRHC TRAN DARTLZJ 2+PhHOS","code_information":[{"code":"2817183","type":"CDM"},{"code":"361","type":"RC"},{"code":"46948","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.5,"setting":"both","billing_class":"facility"},{"gross_charge":830.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPR PROC ABDM/PER/OMENT-PhHOS","code_information":[{"code":"2817184","type":"CDM"},{"code":"361","type":"RC"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.5,"setting":"both","billing_class":"facility"},{"gross_charge":1496.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPENING-PhHOS","code_information":[{"code":"2817185","type":"CDM"},{"code":"361","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"facility"},{"gross_charge":115.5,"setting":"both","billing_class":"professional"}]},{"description":"REMVE SPINE FIXATION DEV-PhHOS","code_information":[{"code":"2817186","type":"CDM"},{"code":"361","type":"RC"},{"code":"22850","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"setting":"both","billing_class":"facility"},{"gross_charge":1377.0,"setting":"both","billing_class":"professional"}]},{"description":"PED CC TRANSPORT 30-74-PhHOS","code_information":[{"code":"2817187","type":"CDM"},{"code":"361","type":"RC"},{"code":"99466","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.75,"setting":"both","billing_class":"facility"},{"gross_charge":440.75,"setting":"both","billing_class":"professional"}]},{"description":"PED CC TRANSPORT ADDL 30-PhHOS","code_information":[{"code":"2817188","type":"CDM"},{"code":"361","type":"RC"},{"code":"99467","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.5,"setting":"both","billing_class":"facility"},{"gross_charge":221.5,"setting":"both","billing_class":"professional"}]},{"description":"EGD ENDO MUCOSAL RESECTN-PhHOS","code_information":[{"code":"2817189","type":"CDM"},{"code":"361","type":"RC"},{"code":"43254","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.5,"setting":"both","billing_class":"facility"},{"gross_charge":500.5,"setting":"both","billing_class":"professional"}]},{"description":"SACROILIAC JT INJ-PhHOSP","code_information":[{"code":"2817190","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"facility"},{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOTOMY, RADIUS-PhHOSP","code_information":[{"code":"2817191","type":"CDM"},{"code":"361","type":"RC"},{"code":"25350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.25,"setting":"both","billing_class":"facility"},{"gross_charge":1280.25,"setting":"both","billing_class":"professional"}]},{"description":"SACROILIAC JT INJ BIL-PhHOSP","code_information":[{"code":"2817192","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":231.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"OSTEOTOMY INCSN 1ST METATARSAL","code_information":[{"code":"2817193","type":"CDM"},{"code":"361","type":"RC"},{"code":"28306","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"setting":"both","billing_class":"facility"},{"gross_charge":758.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOTOMY 1ST METATRSL W/GRPH","code_information":[{"code":"2817194","type":"CDM"},{"code":"361","type":"RC"},{"code":"28307","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.25,"setting":"both","billing_class":"facility"},{"gross_charge":980.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOTOMY MLTPL METATARSALS","code_information":[{"code":"2817195","type":"CDM"},{"code":"361","type":"RC"},{"code":"28309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1679.0,"setting":"both","billing_class":"facility"},{"gross_charge":1679.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ANKLE LIGAMENT-PhHOSP","code_information":[{"code":"2817196","type":"CDM"},{"code":"361","type":"RC"},{"code":"27698","type":"HCPCS"}],"standard_charges":[{"gross_charge":1203.75,"setting":"both","billing_class":"facility"},{"gross_charge":1203.75,"setting":"both","billing_class":"professional"}]},{"description":"RESECT NECK TUMR 5cm/>-PhHOSP","code_information":[{"code":"2817197","type":"CDM"},{"code":"361","type":"RC"},{"code":"21558","type":"HCPCS"}],"standard_charges":[{"gross_charge":2539.0,"setting":"both","billing_class":"facility"},{"gross_charge":2539.0,"setting":"both","billing_class":"professional"}]},{"description":"EGD TUBE/CATH INSERTION-PhHOS","code_information":[{"code":"2817198","type":"CDM"},{"code":"361","type":"RC"},{"code":"43241","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.25,"setting":"both","billing_class":"facility"},{"gross_charge":266.25,"setting":"both","billing_class":"professional"}]},{"description":"RESECTION OF SCROTUM-PhHOSP","code_information":[{"code":"2817199","type":"CDM"},{"code":"361","type":"RC"},{"code":"55150","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.25,"setting":"both","billing_class":"facility"},{"gross_charge":927.25,"setting":"both","billing_class":"professional"}]},{"description":"SK SUB GR F/N/HF/G ADDL-PhHOSP","code_information":[{"code":"2817200","type":"CDM"},{"code":"361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"facility"},{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF FB/SCROTUM-PhHOSP","code_information":[{"code":"2817201","type":"CDM"},{"code":"361","type":"RC"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.25,"setting":"both","billing_class":"facility"},{"gross_charge":664.25,"setting":"both","billing_class":"professional"}]},{"description":"ABSCESS DRAINAGE W/X-RAY-PhHOS","code_information":[{"code":"2817202","type":"CDM"},{"code":"361","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"CPTR ASST BONE SURG-PhHOS","code_information":[{"code":"2817203","type":"CDM"},{"code":"361","type":"RC"},{"code":"0055T","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR DIAPHRAGM HERNIA-PhHOSP","code_information":[{"code":"2817204","type":"CDM"},{"code":"361","type":"RC"},{"code":"39503","type":"HCPCS"}],"standard_charges":[{"gross_charge":10878.5,"setting":"both","billing_class":"facility"},{"gross_charge":10878.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTO/URTL STRIX/STNOSIS-PhHOS","code_information":[{"code":"2817205","type":"CDM"},{"code":"361","type":"RC"},{"code":"52284","type":"HCPCS"}],"standard_charges":[{"gross_charge":3844.5,"setting":"both","billing_class":"facility"},{"gross_charge":3844.5,"setting":"both","billing_class":"professional"}]},{"description":"RMVL SWEAT GLAND LESION-PhHOSP","code_information":[{"code":"2817206","type":"CDM"},{"code":"361","type":"RC"},{"code":"11451","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.25,"setting":"both","billing_class":"facility"},{"gross_charge":624.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST DISLOCATION-PhHOS","code_information":[{"code":"2817207","type":"CDM"},{"code":"361","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.25,"setting":"both","billing_class":"facility"},{"gross_charge":970.25,"setting":"both","billing_class":"professional"}]},{"description":"PROLONGED E/M EA 15M-PhHOSP","code_information":[{"code":"2817208","type":"CDM"},{"code":"361","type":"RC"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"FIXATION KNEE JNT BIL-PhHOSP","code_information":[{"code":"2817209","type":"CDM"},{"code":"361","type":"RC"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":434.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED LAPS PX LIVER-PhHOSP","code_information":[{"code":"2817210","type":"CDM"},{"code":"361","type":"RC"},{"code":"47379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1617.75,"setting":"both","billing_class":"facility"},{"gross_charge":1617.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PANCREAS PX-PhHOS","code_information":[{"code":"2817211","type":"CDM"},{"code":"361","type":"RC"},{"code":"48999","type":"HCPCS"}],"standard_charges":[{"gross_charge":5113.5,"setting":"both","billing_class":"facility"},{"gross_charge":5113.5,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION HALLUX VALGUS-PhHOS","code_information":[{"code":"2817212","type":"CDM"},{"code":"361","type":"RC"},{"code":"28299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1102.75,"setting":"both","billing_class":"facility"},{"gross_charge":1102.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY FUNDOPLASTY-PhHOS","code_information":[{"code":"2817213","type":"CDM"},{"code":"361","type":"RC"},{"code":"43280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.25,"setting":"both","billing_class":"facility"},{"gross_charge":2049.25,"setting":"both","billing_class":"professional"}]},{"description":"OPEN TX RADIUS FRACTURE-PhHOS","code_information":[{"code":"2817214","type":"CDM"},{"code":"361","type":"RC"},{"code":"24666","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.25,"setting":"both","billing_class":"facility"},{"gross_charge":1389.25,"setting":"both","billing_class":"professional"}]},{"description":"CARPAL TUNNEL BIL SURG-PhHOS","code_information":[{"code":"2817215","type":"CDM"},{"code":"361","type":"RC"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1241.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BIOPSY OF MOUTH LESION-PhHOS","code_information":[{"code":"2817216","type":"CDM"},{"code":"361","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"setting":"both","billing_class":"facility"},{"gross_charge":171.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR NSL VLV CLPSE W/RMDL-PhHOS","code_information":[{"code":"2817217","type":"CDM"},{"code":"361","type":"RC"},{"code":"30469","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"facility"},{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY LYMPH NOD BX-PhHOS","code_information":[{"code":"2817218","type":"CDM"},{"code":"361","type":"RC"},{"code":"38570","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.5,"setting":"both","billing_class":"facility"},{"gross_charge":993.5,"setting":"both","billing_class":"professional"}]},{"description":"CIRCUMCISION NEONATE-PhHOS","code_information":[{"code":"2817219","type":"CDM"},{"code":"361","type":"RC"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.5,"setting":"both","billing_class":"facility"},{"gross_charge":278.5,"setting":"both","billing_class":"professional"}]},{"description":"INS TUN IP CATH DIAL OPN-PhHOS","code_information":[{"code":"2817220","type":"CDM"},{"code":"361","type":"RC"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","billing_class":"facility"},{"gross_charge":433.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED LAPS PX SPLEEN-PhHOS","code_information":[{"code":"2817221","type":"CDM"},{"code":"361","type":"RC"},{"code":"38129","type":"HCPCS"}],"standard_charges":[{"gross_charge":1942.75,"setting":"both","billing_class":"facility"},{"gross_charge":1942.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTD HYSTSC PX UTERUS-PhHOS","code_information":[{"code":"2817222","type":"CDM"},{"code":"361","type":"RC"},{"code":"58579","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"facility"},{"gross_charge":97.5,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL REMOVAL OF TOE-PhHOS","code_information":[{"code":"2817223","type":"CDM"},{"code":"361","type":"RC"},{"code":"28160","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.25,"setting":"both","billing_class":"facility"},{"gross_charge":513.25,"setting":"both","billing_class":"professional"}]},{"description":"FUSION OF FOOT BONES-PhHOS","code_information":[{"code":"2817224","type":"CDM"},{"code":"361","type":"RC"},{"code":"28735","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.75,"setting":"both","billing_class":"facility"},{"gross_charge":1509.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED LAPS PX BLADDER-PhHOS","code_information":[{"code":"2817225","type":"CDM"},{"code":"361","type":"RC"},{"code":"51999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"setting":"both","billing_class":"facility"},{"gross_charge":1359.0,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE NECK VESSELS-PhHOS","code_information":[{"code":"2817226","type":"CDM"},{"code":"361","type":"RC"},{"code":"35800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1406.75,"setting":"both","billing_class":"facility"},{"gross_charge":1406.75,"setting":"both","billing_class":"professional"}]},{"description":"ANKLE ARTHROSCOPY/SURG-PhHOS","code_information":[{"code":"2817227","type":"CDM"},{"code":"361","type":"RC"},{"code":"29892","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.5,"setting":"both","billing_class":"facility"},{"gross_charge":1243.5,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHAGOSCPY FLX DX BRUSH-PhHO","code_information":[{"code":"2817228","type":"CDM"},{"code":"361","type":"RC"},{"code":"43197","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHDSIS GRT 2 MTP JNT BIL-PhH","code_information":[{"code":"2817229","type":"CDM"},{"code":"361","type":"RC"},{"code":"28750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1675.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"COLONOSCOPY W/DECMPRSION-PhHOS","code_information":[{"code":"2817230","type":"CDM"},{"code":"361","type":"RC"},{"code":"45393","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"facility"},{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"CREATE EARDRUM BIL OPEN-PhHOS","code_information":[{"code":"2817231","type":"CDM"},{"code":"361","type":"RC"},{"code":"69436","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":466.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXC FT/TOE TUMR 1.5CM/>-PhHOS","code_information":[{"code":"2817232","type":"CDM"},{"code":"361","type":"RC"},{"code":"28041","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"},{"gross_charge":870.25,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM & TREATMENT-PhHOS","code_information":[{"code":"2817233","type":"CDM"},{"code":"361","type":"RC"},{"code":"92019","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"facility"},{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"SINS ENDO W/BLLN DIL BIL-PhHOS","code_information":[{"code":"2817234","type":"CDM"},{"code":"361","type":"RC"},{"code":"31295","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":456.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SINS ENDO SPHND BIL-PhHOS","code_information":[{"code":"2817235","type":"CDM"},{"code":"361","type":"RC"},{"code":"31297","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":416.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"INCISION ACHILLES TENDON-PhHOS","code_information":[{"code":"2817236","type":"CDM"},{"code":"361","type":"RC"},{"code":"27606","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.5,"setting":"both","billing_class":"facility"},{"gross_charge":525.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC INTESTINE LESION(S)-PhHOS","code_information":[{"code":"2817237","type":"CDM"},{"code":"361","type":"RC"},{"code":"44110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1635.25,"setting":"both","billing_class":"facility"},{"gross_charge":1635.25,"setting":"both","billing_class":"professional"}]},{"description":"BRONCHIAL ALLERGY TESTS-PhHOS","code_information":[{"code":"2817238","type":"CDM"},{"code":"361","type":"RC"},{"code":"95070","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","billing_class":"professional"}]},{"description":"OPTX ACUTE SHLDR DISLC-PhHOS","code_information":[{"code":"2817239","type":"CDM"},{"code":"361","type":"RC"},{"code":"23660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.75,"setting":"both","billing_class":"facility"},{"gross_charge":1148.75,"setting":"both","billing_class":"professional"}]},{"description":"RESCET INFR TURBINAT BIL-PhHOS","code_information":[{"code":"2817240","type":"CDM"},{"code":"361","type":"RC"},{"code":"30140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1290.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXC LIMB NERVE LESION-PhHOS","code_information":[{"code":"2817241","type":"CDM"},{"code":"361","type":"RC"},{"code":"64782","type":"HCPCS"}],"standard_charges":[{"gross_charge":882.5,"setting":"both","billing_class":"facility"},{"gross_charge":882.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC LIMB NERVE ADD-ON-PhHOS","code_information":[{"code":"2817242","type":"CDM"},{"code":"361","type":"RC"},{"code":"64783","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.25,"setting":"both","billing_class":"facility"},{"gross_charge":413.25,"setting":"both","billing_class":"professional"}]},{"description":"INSJ SINUS TARSI IMPLANT-PhHOS","code_information":[{"code":"2817243","type":"CDM"},{"code":"361","type":"RC"},{"code":"0335T","type":"HCPCS"}],"standard_charges":[{"gross_charge":8097.0,"setting":"both","billing_class":"facility"},{"gross_charge":8097.0,"setting":"both","billing_class":"professional"}]},{"description":"SCOPE PLANTAR FASCIOTOMY-PhHOS","code_information":[{"code":"2817244","type":"CDM"},{"code":"361","type":"RC"},{"code":"29893","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.5,"setting":"both","billing_class":"facility"},{"gross_charge":840.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PX LEG/ANKLE-PhHOS","code_information":[{"code":"2817245","type":"CDM"},{"code":"361","type":"RC"},{"code":"27899","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"setting":"both","billing_class":"facility"},{"gross_charge":867.0,"setting":"both","billing_class":"professional"}]},{"description":"CLR OUTER EAR CANAL BIL-PhHOS","code_information":[{"code":"2817246","type":"CDM"},{"code":"361","type":"RC"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":294.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED PROCEDUR RECTUM-PhHOS","code_information":[{"code":"2817247","type":"CDM"},{"code":"361","type":"RC"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.5,"setting":"both","billing_class":"facility"},{"gross_charge":2354.5,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX MAX-PhHOS","code_information":[{"code":"2817248","type":"CDM"},{"code":"361","type":"RC"},{"code":"31233","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.25,"setting":"both","billing_class":"facility"},{"gross_charge":260.25,"setting":"both","billing_class":"professional"}]},{"description":"EXPLORE/TX ANKLE JOINT-PhHOS","code_information":[{"code":"2817249","type":"CDM"},{"code":"361","type":"RC"},{"code":"27620","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"setting":"both","billing_class":"facility"},{"gross_charge":864.0,"setting":"both","billing_class":"professional"}]},{"description":"SINS ENDO W/DIL FRNT BIL-PhHOS","code_information":[{"code":"2817250","type":"CDM"},{"code":"361","type":"RC"},{"code":"31296","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":518.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAP ESOPH HER RPR W/MESH-PhHO","code_information":[{"code":"2819587","type":"CDM"},{"code":"361","type":"RC"},{"code":"43282","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.5,"setting":"both","billing_class":"facility"},{"gross_charge":3282.5,"setting":"both","billing_class":"professional"}]},{"description":"REP ELBOW PERC-PhHOS","code_information":[{"code":"2819588","type":"CDM"},{"code":"361","type":"RC"},{"code":"24357","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"setting":"both","billing_class":"facility"},{"gross_charge":508.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF HEEL BONE-PhHOS","code_information":[{"code":"2819590","type":"CDM"},{"code":"361","type":"RC"},{"code":"28118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.5,"setting":"both","billing_class":"facility"},{"gross_charge":1143.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF HEEL SPUR-PhHOS","code_information":[{"code":"2819591","type":"CDM"},{"code":"361","type":"RC"},{"code":"28119","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.5,"setting":"both","billing_class":"facility"},{"gross_charge":990.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF FOOT LESION-PhHOS","code_information":[{"code":"2819592","type":"CDM"},{"code":"361","type":"RC"},{"code":"28080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"facility"},{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"REM ANKLE JOINT LINING-PhHOS","code_information":[{"code":"2819593","type":"CDM"},{"code":"361","type":"RC"},{"code":"27625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.75,"setting":"both","billing_class":"facility"},{"gross_charge":1073.75,"setting":"both","billing_class":"professional"}]},{"description":"OTOLARYNGOLOGC UNDR ANES-PhHOS","code_information":[{"code":"2819594","type":"CDM"},{"code":"361","type":"RC"},{"code":"92502","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"ACNE SURGERY-PhHOS","code_information":[{"code":"2819595","type":"CDM"},{"code":"361","type":"RC"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"SKN FUL GFT SCLP/ARM/LEG-PhHOS","code_information":[{"code":"2819596","type":"CDM"},{"code":"361","type":"RC"},{"code":"15220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"setting":"both","billing_class":"facility"},{"gross_charge":1321.0,"setting":"both","billing_class":"professional"}]},{"description":"TAH RAD DISCT FOR DEBULK-PhHOS","code_information":[{"code":"2819597","type":"CDM"},{"code":"361","type":"RC"},{"code":"58953","type":"HCPCS"}],"standard_charges":[{"gross_charge":3430.5,"setting":"both","billing_class":"facility"},{"gross_charge":3705.75,"setting":"both","billing_class":"professional"}]},{"description":"RELEASE OF URETER-PhHOS","code_information":[{"code":"2819598","type":"CDM"},{"code":"361","type":"RC"},{"code":"50715","type":"HCPCS"}],"standard_charges":[{"gross_charge":2056.5,"setting":"both","billing_class":"facility"},{"gross_charge":2056.5,"setting":"both","billing_class":"professional"}]},{"description":"EXPLOR/TREAT ANKLE JOINT-PhHOS","code_information":[{"code":"2819599","type":"CDM"},{"code":"361","type":"RC"},{"code":"27610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"setting":"both","billing_class":"facility"},{"gross_charge":1120.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISE INTRSPINL LES LMBR-PhHOS","code_information":[{"code":"2819600","type":"CDM"},{"code":"361","type":"RC"},{"code":"63267","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.75,"setting":"both","billing_class":"facility"},{"gross_charge":2784.75,"setting":"both","billing_class":"professional"}]},{"description":"LAM FACT/FRMT ARRD LUM 1-PhHOS","code_information":[{"code":"2819601","type":"CDM"},{"code":"361","type":"RC"},{"code":"63052","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.75,"setting":"both","billing_class":"facility"},{"gross_charge":485.75,"setting":"both","billing_class":"professional"}]},{"description":"LAM FACTC/FRT ART LUM EA-PhHOS","code_information":[{"code":"2819602","type":"CDM"},{"code":"361","type":"RC"},{"code":"63053","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.5,"setting":"both","billing_class":"facility"},{"gross_charge":330.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE NAIL 6 OR MORE-PhHOS","code_information":[{"code":"2819603","type":"CDM"},{"code":"361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"INJECTION TREATMENT EYE-PhHOS","code_information":[{"code":"2819604","type":"CDM"},{"code":"361","type":"RC"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"facility"},{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"INC OF TOE SINGLE TENDON-PhHOS","code_information":[{"code":"2819605","type":"CDM"},{"code":"361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.25,"setting":"both","billing_class":"facility"},{"gross_charge":433.25,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF FOOT BONES-PhHOS","code_information":[{"code":"2819607","type":"CDM"},{"code":"361","type":"RC"},{"code":"28737","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"setting":"both","billing_class":"facility"},{"gross_charge":1170.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDO PANCREATOSCOPY-PhHOS","code_information":[{"code":"2819608","type":"CDM"},{"code":"361","type":"RC"},{"code":"43273","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.5,"setting":"both","billing_class":"facility"},{"gross_charge":222.5,"setting":"both","billing_class":"professional"}]},{"description":"X-RAY BILE DUCT/PANCREAS-PhHOS","code_information":[{"code":"2819609","type":"CDM"},{"code":"361","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.5,"setting":"both","billing_class":"facility"},{"gross_charge":26.5,"setting":"both","billing_class":"professional"}]},{"description":"X-RAYS AT SURGERY ADD-ON-PhHOS","code_information":[{"code":"2819610","type":"CDM"},{"code":"361","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.25,"setting":"both","billing_class":"facility"},{"gross_charge":19.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE EYELID LESION-PhHOS","code_information":[{"code":"2819611","type":"CDM"},{"code":"361","type":"RC"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","billing_class":"facility"},{"gross_charge":188.25,"setting":"both","billing_class":"professional"}]},{"description":"GONIOTOMY-PhHOS","code_information":[{"code":"2819612","type":"CDM"},{"code":"361","type":"RC"},{"code":"65820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1553.5,"setting":"both","billing_class":"facility"},{"gross_charge":1553.5,"setting":"both","billing_class":"professional"}]},{"description":"X-RAY PANCREAS ENDO-PhHOS","code_information":[{"code":"2819613","type":"CDM"},{"code":"361","type":"RC"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"facility"},{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"X-RAY BILE/PANC ENDO-PhHOS","code_information":[{"code":"2819614","type":"CDM"},{"code":"361","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.5,"setting":"both","billing_class":"facility"},{"gross_charge":61.5,"setting":"both","billing_class":"professional"}]},{"description":"NEW EYE EXAM & TREAT-PhHOS","code_information":[{"code":"2819615","type":"CDM"},{"code":"361","type":"RC"},{"code":"92018","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.75,"setting":"both","billing_class":"facility"},{"gross_charge":163.75,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE WINDPIPE LESION-PhHOS","code_information":[{"code":"2819617","type":"CDM"},{"code":"361","type":"RC"},{"code":"31820","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"setting":"both","billing_class":"facility"},{"gross_charge":836.0,"setting":"both","billing_class":"professional"}]},{"description":"XCAPSL CTRC RMVL INSJ 1+PhHOS","code_information":[{"code":"2819618","type":"CDM"},{"code":"361","type":"RC"},{"code":"66991","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"setting":"both","billing_class":"facility"},{"gross_charge":799.0,"setting":"both","billing_class":"professional"}]},{"description":"CORRECT MALROTATIN BOWEL-PhHOS","code_information":[{"code":"2819619","type":"CDM"},{"code":"361","type":"RC"},{"code":"44055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2823.25,"setting":"both","billing_class":"facility"},{"gross_charge":2823.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF THYROID-PhHOS","code_information":[{"code":"2819620","type":"CDM"},{"code":"361","type":"RC"},{"code":"60252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2499.0,"setting":"both","billing_class":"facility"},{"gross_charge":2499.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPLANT NEUROELECTRODES-PhHOS","code_information":[{"code":"2819621","type":"CDM"},{"code":"361","type":"RC"},{"code":"64575","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"setting":"both","billing_class":"facility"},{"gross_charge":606.0,"setting":"both","billing_class":"professional"}]},{"description":"X-RAY FEMALE GENITAL TR-PhHOS","code_information":[{"code":"2819622","type":"CDM"},{"code":"361","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"facility"},{"gross_charge":34.5,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"EXPLORE WOUND CHEST-PhHOS","code_information":[{"code":"2819623","type":"CDM"},{"code":"361","type":"RC"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.75,"setting":"both","billing_class":"facility"},{"gross_charge":1150.75,"setting":"both","billing_class":"professional"}]},{"description":"VISUALIZATION WINDPIPE-PhHOS","code_information":[{"code":"2819624","type":"CDM"},{"code":"361","type":"RC"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.75,"setting":"both","billing_class":"facility"},{"gross_charge":328.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF THYROID-PhHOS","code_information":[{"code":"2819625","type":"CDM"},{"code":"361","type":"RC"},{"code":"60271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.25,"setting":"both","billing_class":"facility"},{"gross_charge":1995.25,"setting":"both","billing_class":"professional"}]},{"description":"EXCISION STOMACH LES-PhHOS","code_information":[{"code":"2819626","type":"CDM"},{"code":"361","type":"RC"},{"code":"43611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2244.0,"setting":"both","billing_class":"facility"},{"gross_charge":2244.0,"setting":"both","billing_class":"professional"}]},{"description":"PERQ VERTEBRAL AUGMENT-PhHOS","code_information":[{"code":"2819627","type":"CDM"},{"code":"361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"setting":"both","billing_class":"facility"},{"gross_charge":957.0,"setting":"both","billing_class":"professional"}]},{"description":"PERQ VERTEBRAL AUGMENT-PhHOS","code_information":[{"code":"2819628","type":"CDM"},{"code":"361","type":"RC"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.5,"setting":"both","billing_class":"facility"},{"gross_charge":890.5,"setting":"both","billing_class":"professional"}]},{"description":"PERQ VERTEBRAL AUGMENT-PhHOS","code_information":[{"code":"2819629","type":"CDM"},{"code":"361","type":"RC"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.25,"setting":"both","billing_class":"facility"},{"gross_charge":409.25,"setting":"both","billing_class":"professional"}]},{"description":"PRIN CARE MGMT ST 30-PhHOS","code_information":[{"code":"2819630","type":"CDM"},{"code":"361","type":"RC"},{"code":"99424","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"setting":"both","billing_class":"facility"},{"gross_charge":154.0,"setting":"both","billing_class":"professional"}]},{"description":"PRIN CARE MGMT EA ADDL-PhHOS","code_information":[{"code":"2819631","type":"CDM"},{"code":"361","type":"RC"},{"code":"99425","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"setting":"both","billing_class":"facility"},{"gross_charge":111.0,"setting":"both","billing_class":"professional"}]},{"description":"PRIN CARE STAFF 1ST 30-PhHOS","code_information":[{"code":"2819632","type":"CDM"},{"code":"361","type":"RC"},{"code":"99426","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"setting":"both","billing_class":"facility"},{"gross_charge":117.0,"setting":"both","billing_class":"professional"}]},{"description":"PRIN CARE STAFF EA ADDL-PhHOS","code_information":[{"code":"2819633","type":"CDM"},{"code":"361","type":"RC"},{"code":"99427","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"facility"},{"gross_charge":89.25,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION ASTIGMATISM-PhHOS","code_information":[{"code":"2819634","type":"CDM"},{"code":"361","type":"RC"},{"code":"65772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.5,"setting":"both","billing_class":"facility"},{"gross_charge":1095.5,"setting":"both","billing_class":"professional"}]},{"description":"BIL LOW BACK DISK SURG-PhHOS","code_information":[{"code":"2819635","type":"CDM"},{"code":"361","type":"RC"},{"code":"63030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3524.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":3524.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SPINAL DISK SURG ADD-ON-PhHOS","code_information":[{"code":"2819636","type":"CDM"},{"code":"361","type":"RC"},{"code":"63035","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"setting":"both","billing_class":"facility"},{"gross_charge":363.0,"setting":"both","billing_class":"professional"}]},{"description":"BIL SPINL DISK SG ADD-ON-PhHOS","code_information":[{"code":"2819637","type":"CDM"},{"code":"361","type":"RC"},{"code":"63035","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":544.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPOS INTRAOCULAR LENS-PhHOS","code_information":[{"code":"2819638","type":"CDM"},{"code":"361","type":"RC"},{"code":"66825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.75,"setting":"both","billing_class":"facility"},{"gross_charge":1561.75,"setting":"both","billing_class":"professional"}]},{"description":"EMERGENCY DEPT VISIT-PhHOS","code_information":[{"code":"2819639","type":"CDM"},{"code":"361","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"setting":"both","billing_class":"facility"},{"gross_charge":302.0,"setting":"both","billing_class":"professional"}]},{"description":"VASCULAR SURGERY-PhHOS","code_information":[{"code":"2819640","type":"CDM"},{"code":"361","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2266.5,"setting":"both","billing_class":"facility"},{"gross_charge":2266.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL OUTP LEVEL 5 NEW-PhHOS","code_information":[{"code":"2819641","type":"CDM"},{"code":"361","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.5,"setting":"both","billing_class":"facility"},{"gross_charge":273.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX BIL-PhHOS","code_information":[{"code":"2819642","type":"CDM"},{"code":"361","type":"RC"},{"code":"52332","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":428.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REMOVE/GRAFT FOOT LESION-PhHOS","code_information":[{"code":"2819643","type":"CDM"},{"code":"361","type":"RC"},{"code":"28107","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.25,"setting":"both","billing_class":"facility"},{"gross_charge":646.25,"setting":"both","billing_class":"professional"}]},{"description":"ANKL ARTHRO DEBRIDE LMTD-PhHOS","code_information":[{"code":"2819644","type":"CDM"},{"code":"361","type":"RC"},{"code":"29897","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.75,"setting":"both","billing_class":"facility"},{"gross_charge":929.75,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT THIGH FRACTURE-PhHOS","code_information":[{"code":"2819645","type":"CDM"},{"code":"361","type":"RC"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.25,"setting":"both","billing_class":"facility"},{"gross_charge":1292.25,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROSCOPY SM INTESTINE-PhHOS","code_information":[{"code":"2819646","type":"CDM"},{"code":"361","type":"RC"},{"code":"44376","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"setting":"both","billing_class":"facility"},{"gross_charge":557.0,"setting":"both","billing_class":"professional"}]},{"description":"L COLECTOMY/COLOPROCTSTMY-PhHO","code_information":[{"code":"2819647","type":"CDM"},{"code":"361","type":"RC"},{"code":"44208","type":"HCPCS"}],"standard_charges":[{"gross_charge":3714.0,"setting":"both","billing_class":"facility"},{"gross_charge":3714.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF THYROID-PhHOS","code_information":[{"code":"2819648","type":"CDM"},{"code":"361","type":"RC"},{"code":"60271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.25,"setting":"both","billing_class":"facility"},{"gross_charge":1178.25,"setting":"both","billing_class":"professional"}]},{"description":"LAP SALPINGO OOPHERECTMY-PhHOS","code_information":[{"code":"2819649","type":"CDM"},{"code":"361","type":"RC"},{"code":"58679","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.25,"setting":"both","billing_class":"facility"},{"gross_charge":1438.25,"setting":"both","billing_class":"professional"}]},{"description":"ESOPH TAMPONADE W/BALLOON-PhHO","code_information":[{"code":"2819651","type":"CDM"},{"code":"361","type":"RC"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"setting":"both","billing_class":"facility"},{"gross_charge":396.0,"setting":"both","billing_class":"professional"}]},{"description":"EGD ESOPHAG FNDOPLSTY-PhHOS","code_information":[{"code":"2819652","type":"CDM"},{"code":"361","type":"RC"},{"code":"43210","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.5,"setting":"both","billing_class":"facility"},{"gross_charge":829.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROTOMY, ELBOW-PhHOS","code_information":[{"code":"2819653","type":"CDM"},{"code":"361","type":"RC"},{"code":"24101","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"setting":"both","billing_class":"facility"},{"gross_charge":960.0,"setting":"both","billing_class":"professional"}]},{"description":"REINSERT SPINAL FIXATION-PhHOS","code_information":[{"code":"2819654","type":"CDM"},{"code":"361","type":"RC"},{"code":"22849","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.5,"setting":"both","billing_class":"facility"},{"gross_charge":2721.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SHOULDER CAPSULE-PhHOS","code_information":[{"code":"2819655","type":"CDM"},{"code":"361","type":"RC"},{"code":"23462","type":"HCPCS"}],"standard_charges":[{"gross_charge":2019.75,"setting":"both","billing_class":"facility"},{"gross_charge":2019.75,"setting":"both","billing_class":"professional"}]},{"description":"I&D ABSCESS P-SPINE L/S-PhHOSP","code_information":[{"code":"2819656","type":"CDM"},{"code":"361","type":"RC"},{"code":"22015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1801.5,"setting":"both","billing_class":"facility"},{"gross_charge":1801.5,"setting":"both","billing_class":"professional"}]},{"description":"SYNVCT FOOT JOINT LINING-PhHOS","code_information":[{"code":"2819657","type":"CDM"},{"code":"361","type":"RC"},{"code":"28070","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"setting":"both","billing_class":"facility"},{"gross_charge":652.0,"setting":"both","billing_class":"professional"}]},{"description":"IP/OPS DC DAY MGT=<30M-PhHOSP","code_information":[{"code":"2819658","type":"CDM"},{"code":"361","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"PYLOROPLASTY-PhHOSP","code_information":[{"code":"2819659","type":"CDM"},{"code":"361","type":"RC"},{"code":"43800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.75,"setting":"both","billing_class":"facility"},{"gross_charge":1771.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST < 3 CM RDC-PhHO","code_information":[{"code":"2819660","type":"CDM"},{"code":"361","type":"RC"},{"code":"49591","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.5,"setting":"both","billing_class":"facility"},{"gross_charge":401.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST<3 NCR/STRN-PhHO","code_information":[{"code":"2819661","type":"CDM"},{"code":"361","type":"RC"},{"code":"49592","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.5,"setting":"both","billing_class":"facility"},{"gross_charge":559.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST 3-10 RDC-PhHOSP","code_information":[{"code":"2819662","type":"CDM"},{"code":"361","type":"RC"},{"code":"49593","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.5,"setting":"both","billing_class":"facility"},{"gross_charge":673.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST 3-10 NCR/STR-Ph","code_information":[{"code":"2819663","type":"CDM"},{"code":"361","type":"RC"},{"code":"49594","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"setting":"both","billing_class":"facility"},{"gross_charge":878.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST > 10 RDC-PhHOS","code_information":[{"code":"2819664","type":"CDM"},{"code":"361","type":"RC"},{"code":"49595","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.25,"setting":"both","billing_class":"facility"},{"gross_charge":906.25,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN 1ST>10 NCR/STRN-PhH","code_information":[{"code":"2819665","type":"CDM"},{"code":"361","type":"RC"},{"code":"49596","type":"HCPCS"}],"standard_charges":[{"gross_charge":1203.75,"setting":"both","billing_class":"facility"},{"gross_charge":1203.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR < 3 RDC-PhHOS","code_information":[{"code":"2819666","type":"CDM"},{"code":"361","type":"RC"},{"code":"49613","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"setting":"both","billing_class":"facility"},{"gross_charge":495.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR<3 NCR/STRN-PhHO","code_information":[{"code":"2819667","type":"CDM"},{"code":"361","type":"RC"},{"code":"49614","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"setting":"both","billing_class":"facility"},{"gross_charge":672.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR 3-10 RDC-PhHOS","code_information":[{"code":"2819668","type":"CDM"},{"code":"361","type":"RC"},{"code":"49615","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"setting":"both","billing_class":"facility"},{"gross_charge":752.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR 3-10 NCR/STR-Ph","code_information":[{"code":"2819669","type":"CDM"},{"code":"361","type":"RC"},{"code":"49616","type":"HCPCS"}],"standard_charges":[{"gross_charge":1010.75,"setting":"both","billing_class":"facility"},{"gross_charge":1010.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR > 10 RDC-PhHOS","code_information":[{"code":"2819670","type":"CDM"},{"code":"361","type":"RC"},{"code":"49617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.75,"setting":"both","billing_class":"facility"},{"gross_charge":1040.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR AA HRN RCR>10 NCR/STRN-PhH","code_information":[{"code":"2819671","type":"CDM"},{"code":"361","type":"RC"},{"code":"49618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"setting":"both","billing_class":"facility"},{"gross_charge":1459.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR PARASTOMAL HERNIA RDC-PhHO","code_information":[{"code":"2819672","type":"CDM"},{"code":"361","type":"RC"},{"code":"49621","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.5,"setting":"both","billing_class":"facility"},{"gross_charge":872.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR PARASTOMAL HRNA NCR/STR-Ph","code_information":[{"code":"2819673","type":"CDM"},{"code":"361","type":"RC"},{"code":"49622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.25,"setting":"both","billing_class":"facility"},{"gross_charge":1077.25,"setting":"both","billing_class":"professional"}]},{"description":"RMVL NINFCT MESH HERNIA RPR-Ph","code_information":[{"code":"2819674","type":"CDM"},{"code":"361","type":"RC"},{"code":"49623","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.5,"setting":"both","billing_class":"facility"},{"gross_charge":283.5,"setting":"both","billing_class":"professional"}]},{"description":"PRLNG IP/OBS E/M 15 MIN-PhHOS","code_information":[{"code":"2819675","type":"CDM"},{"code":"361","type":"RC"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"},{"gross_charge":74.0,"setting":"both","billing_class":"professional"}]},{"description":"MASTECTOMY SMPL COMP-BIL-PhHOS","code_information":[{"code":"2819676","type":"CDM"},{"code":"361","type":"RC"},{"code":"19303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2846.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":2846.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"INTUBATION-PhHOS","code_information":[{"code":"2819677","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.75,"setting":"both","billing_class":"facility"},{"gross_charge":1295.75,"setting":"both","billing_class":"professional"}]},{"description":"EGD TRANSMUR DRAIN CYST-PhHOS","code_information":[{"code":"2819678","type":"CDM"},{"code":"361","type":"RC"},{"code":"43240","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.5,"setting":"both","billing_class":"facility"},{"gross_charge":730.5,"setting":"both","billing_class":"professional"}]},{"description":"ENDOSCOPY SMALL BOWEL-PhHOS","code_information":[{"code":"2819679","type":"CDM"},{"code":"361","type":"RC"},{"code":"44378","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.25,"setting":"both","billing_class":"professional"}]},{"description":"DILATION FLUID,EYE-PhHOS","code_information":[{"code":"2819680","type":"CDM"},{"code":"361","type":"RC"},{"code":"66174","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.5,"setting":"both","billing_class":"facility"},{"gross_charge":1401.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE FLUID, W/DEVICE-PhHOS","code_information":[{"code":"2819681","type":"CDM"},{"code":"361","type":"RC"},{"code":"66175","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"setting":"both","billing_class":"facility"},{"gross_charge":1472.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTECTOMY STERNUM PARTAL-PhHOS","code_information":[{"code":"2819682","type":"CDM"},{"code":"361","type":"RC"},{"code":"21620","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"setting":"both","billing_class":"facility"},{"gross_charge":960.0,"setting":"both","billing_class":"professional"}]},{"description":"NASOPHARYNGOSCOPY, BILAT-PhHOS","code_information":[{"code":"2819683","type":"CDM"},{"code":"361","type":"RC"},{"code":"69706","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"setting":"both","billing_class":"facility"},{"gross_charge":455.0,"setting":"both","billing_class":"professional"}]},{"description":"SMDSC W/BAND LIGATION-PhHOS","code_information":[{"code":"2819684","type":"CDM"},{"code":"361","type":"RC"},{"code":"45350","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.75,"setting":"both","billing_class":"facility"},{"gross_charge":188.75,"setting":"both","billing_class":"professional"}]},{"description":"SESAMOIDECTOMY, 1ST TOE-PhHOS","code_information":[{"code":"2819685","type":"CDM"},{"code":"361","type":"RC"},{"code":"28315","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.25,"setting":"both","billing_class":"facility"},{"gross_charge":613.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR BROW PTOSIS-PhHOS","code_information":[{"code":"2819686","type":"CDM"},{"code":"361","type":"RC"},{"code":"67900","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.5,"setting":"both","billing_class":"facility"},{"gross_charge":933.5,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG INPT EVAL ADD15M-PhHOS","code_information":[{"code":"2819687","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0316","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.25,"setting":"both","billing_class":"facility"},{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG ASLEEP AND AWAKE-READ","code_information":[{"code":"2820010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1711.75,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG AWAKE AND DROWSY-READ","code_information":[{"code":"2820011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.5,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG COMA OR SLEEP ONLY-READ","code_information":[{"code":"2820014","type":"CDM"},{"code":"740","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1515.75,"setting":"both","billing_class":"facility"},{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"EKG-READ","code_information":[{"code":"2820020","type":"CDM"},{"code":"730","type":"RC"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.75,"setting":"both","billing_class":"facility"},{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"EEG WO VIDEO 2-12H-READ","code_information":[{"code":"2820021","type":"CDM"},{"code":"740","type":"RC"},{"code":"95717","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG WO VIDEO 12-26H-READ","code_information":[{"code":"2820024","type":"CDM"},{"code":"740","type":"RC"},{"code":"95719","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"EEG W VIDEO 2-12H-READ","code_information":[{"code":"2820027","type":"CDM"},{"code":"740","type":"RC"},{"code":"95718","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"setting":"both","billing_class":"facility"},{"gross_charge":253.0,"setting":"both","billing_class":"professional"}]},{"description":"EEG W VIDEO 12-26HR-READ","code_information":[{"code":"2820031","type":"CDM"},{"code":"740","type":"RC"},{"code":"95720","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"EEG DIGITAL ANALYSIS-READ","code_information":[{"code":"2820035","type":"CDM"},{"code":"740","type":"RC"},{"code":"95957","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.25,"setting":"both","billing_class":"facility"},{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"HOME SLEEP TEST-READ","code_information":[{"code":"2820399","type":"CDM"},{"code":"740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG EXT MONITOR 41-60MIN-READ","code_information":[{"code":"2820812","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"EEG EXT MONITOR 61-119MIN-READ","code_information":[{"code":"2820813","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.5,"setting":"both","billing_class":"facility"},{"gross_charge":167.5,"setting":"both","billing_class":"professional"}]},{"description":"GI IMAGE (PILL CAM)-READ","code_information":[{"code":"2821126","type":"CDM"},{"code":"740","type":"RC"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"facility"},{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"SLEEP STUDY 6/> YRS-READ","code_information":[{"code":"2822010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"setting":"both","billing_class":"facility"},{"gross_charge":178.5,"setting":"both","billing_class":"professional"}]},{"description":"SLEEP STUDY 6/>YRS W/CPAP-READ","code_information":[{"code":"2822011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"facility"},{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"MULTIPLE SLEEP STUDY-READ","code_information":[{"code":"2822060","type":"CDM"},{"code":"740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.25,"setting":"both","billing_class":"facility"},{"gross_charge":110.25,"setting":"both","billing_class":"professional"}]},{"description":"PLETHYSMOGRAPHY (PFT)-READ","code_information":[{"code":"2824726","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"facility"},{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"CARPAL TUNNEL INJ-MHCF","code_information":[{"code":"2850011","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ TENDON SHEATH/LIGAMNT-MHCF","code_information":[{"code":"2850012","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ TENDON ORIGIN/INSERT-MHCF","code_information":[{"code":"2850013","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 1/2 MISCL-MHCF","code_information":[{"code":"2850014","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 3 MUSCL-MHCF","code_information":[{"code":"2850015","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN/INJ SM JNT/BURS BIL-MHCF","code_information":[{"code":"2850016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ SM JNT/BURSA-MHCF","code_information":[{"code":"2850017","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN/INJ MED JNT/BUR BIL-MHCF","code_information":[{"code":"2850018","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN/INJ MED JNT/BURSA-MHCF","code_information":[{"code":"2850019","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN/INJ LG JNT/BURS BIL-MHCF","code_information":[{"code":"2850020","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN/INJ LG JNT/BURSA-MHCF","code_information":[{"code":"2850021","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ CRV/THR WO I-MHCF","code_information":[{"code":"2850034","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ CRV/TH W/IMA-MHCF","code_information":[{"code":"2850035","type":"CDM"},{"code":"361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ LUMSAC WO IM-MHCF","code_information":[{"code":"2850036","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.25,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ LUMB/SAC W/I-MHCF","code_information":[{"code":"2850037","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"SCS IMPLNT NEUROSTIMULAT-MHCF","code_information":[{"code":"2850040","type":"CDM"},{"code":"361","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":16470.0,"setting":"both","billing_class":"facility"}]},{"description":"NB OCCIPITAL BIL-MHCF","code_information":[{"code":"2850047","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB OCCIPITAL LT-MHCF","code_information":[{"code":"2850048","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB OCCIPITAL RT-MHCF","code_information":[{"code":"2850049","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB INTERCOSTAL SINGLE-MHCF","code_information":[{"code":"2850063","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"NB INTERCOSTAL MULTIPLE-MHCF","code_information":[{"code":"2850064","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NB ILIOINGUIN/ILOHYPOGAST-MHCF","code_information":[{"code":"2850065","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1818.5,"setting":"both","billing_class":"facility"}]},{"description":"NB FEMORAL BIL-MHCF","code_information":[{"code":"2850070","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-MHCF","code_information":[{"code":"2850071","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-MHCF","code_information":[{"code":"2850072","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB OTHER PERIPHERAL-MHCF","code_information":[{"code":"2850073","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"TRANSF EPI INJ C/T BIL-MHC","code_information":[{"code":"2850074","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ C/T LT-MHCF","code_information":[{"code":"2850075","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T RT-MHCF","code_information":[{"code":"2850076","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD LT-MHCF","code_information":[{"code":"2850077","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD RT-MHCF","code_information":[{"code":"2850078","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 LT-MHCF","code_information":[{"code":"2850079","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 RT-MHCF","code_information":[{"code":"2850080","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 BI-MHCF","code_information":[{"code":"2850081","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ L/SAC A RT-MHCF","code_information":[{"code":"2850082","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A LT-MHCF","code_information":[{"code":"2850083","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A BI-MHCF","code_information":[{"code":"2850084","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1718.5,"setting":"both","billing_class":"facility"}]},{"description":"FACET CER/THORA LEV 1 BIL-MHCF","code_information":[{"code":"2850085","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA LEV 1 RT-MHCF","code_information":[{"code":"2850086","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA LEV 1 LT-MHCF","code_information":[{"code":"2850087","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THOR L2 ADD BIL-MHCF","code_information":[{"code":"2850088","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THOR L2 ADD RT-MHCF","code_information":[{"code":"2850089","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THOR L2 ADD LT-MHCF","code_information":[{"code":"2850090","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THORA NB L3 BIL-MHCF","code_information":[{"code":"2850091","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA NB L3 RT-MHCF","code_information":[{"code":"2850092","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA NB L3 LT-MHCF","code_information":[{"code":"2850093","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 LT-MHCF","code_information":[{"code":"2850094","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 RT-MHCF","code_information":[{"code":"2850095","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SACRAL LI BIL-MHCF","code_information":[{"code":"2850096","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L2 ADDL RT-MHCF","code_information":[{"code":"2850097","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL LT-MHCF","code_information":[{"code":"2850098","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL BIL-MHCF","code_information":[{"code":"2850099","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L3 ADDL RT-MHCF","code_information":[{"code":"2850100","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL LT-MHCF","code_information":[{"code":"2850101","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL BIL-MHCF","code_information":[{"code":"2850102","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"setting":"both","billing_class":"facility"}]},{"description":"SPHENOPALATINE GANGL BL-MHCF","code_information":[{"code":"2850103","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"NB STELLATE GANGLION BIL-MHCF","code_information":[{"code":"2850104","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3435.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB STELLATE GANGLION LT-MHCF","code_information":[{"code":"2850105","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB STELLATE GANGLION RT-MHCF","code_information":[{"code":"2850106","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SYMPAT BL THOR/LUMB/CAUD-MHCF","code_information":[{"code":"2850108","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NB CELIAC PEL INJ-MHCF","code_information":[{"code":"2850109","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.25,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODENERV MUSC-MHCF","code_information":[{"code":"2850111","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT-MHCF","code_information":[{"code":"2850115","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":6067.5,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT BIL-MHCF","code_information":[{"code":"2850116","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":8869.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL BIL-MHCF","code_information":[{"code":"2850117","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL-MHCF","code_information":[{"code":"2850118","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2416.25,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT NRV L/S-MHCF","code_information":[{"code":"2850119","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6067.5,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT NRV L/S BIL-MHCF","code_information":[{"code":"2850120","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":8869.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT N ADDL-MHCF","code_information":[{"code":"2850121","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":2416.25,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT N ADDL BIL-MHCF","code_information":[{"code":"2850122","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ MJR JNT/BRSA W/US-MHCF","code_information":[{"code":"2850123","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.5,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO LOCALIZATION-MHCF","code_information":[{"code":"2850132","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO GUIDE&LOCAL-MHCF","code_information":[{"code":"2850133","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"facility"}]},{"description":"US GUIDANCE-MHCF","code_information":[{"code":"2850134","type":"CDM"},{"code":"320","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"setting":"both","billing_class":"facility"}]},{"description":"IMPL DRG PUMP REFILL-MHCF","code_information":[{"code":"2850136","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.5,"setting":"both","billing_class":"facility"}]},{"description":"SACROILIAC JT INJ BIL-MHCF","code_information":[{"code":"2850160","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ RT-MHCF","code_information":[{"code":"2850161","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ LT-MHCF","code_information":[{"code":"2850162","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"LOW OSM CON 300-399MG/ML-MHCF","code_information":[{"code":"2850208","type":"CDM"},{"code":"255","type":"RC"}],"standard_charges":[{"gross_charge":14.25,"setting":"both","billing_class":"facility"}]},{"description":"LOW OSM 200-299/ML GEN-MHCF","code_information":[{"code":"2850209","type":"CDM"},{"code":"255","type":"RC"}],"standard_charges":[{"gross_charge":14.25,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ SM JNT/BUR W/US-MHCF","code_information":[{"code":"2850250","type":"CDM"},{"code":"361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ INT JNT/BUR W/US-MHCF","code_information":[{"code":"2850252","type":"CDM"},{"code":"361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"}]},{"description":"DESTROY NERV FC MSCL-MHCF","code_information":[{"code":"2850256","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN MUSC NECK-MHCF","code_information":[{"code":"2850257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN 1 EXT 1-4 MUSC-MHCF","code_information":[{"code":"2850258","type":"CDM"},{"code":"361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN 1 EXT 1-4 ADDL-MHCF","code_information":[{"code":"2850259","type":"CDM"},{"code":"361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN 1 EXT 5/> MUS-MHCF","code_information":[{"code":"2850260","type":"CDM"},{"code":"361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN 1 EXT 5/> ADDL-MHCF","code_information":[{"code":"2850261","type":"CDM"},{"code":"361","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN TRUNK 1-5-MHCF","code_information":[{"code":"2850262","type":"CDM"},{"code":"361","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODEN TRUNK 6/>-MHCF","code_information":[{"code":"2850263","type":"CDM"},{"code":"361","type":"RC"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"setting":"both","billing_class":"facility"}]},{"description":"TAP BLOCK UNIL INJ-MHCF","code_information":[{"code":"2850264","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"}]},{"description":"INJ AA&STRD GENCL NRV-MHCF","code_information":[{"code":"2850265","type":"CDM"},{"code":"361","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE LOC BY XRAY-MHCF","code_information":[{"code":"2850266","type":"CDM"},{"code":"361","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"facility"}]},{"description":"ANES MHCF MAC 0-30MINS","code_information":[{"code":"2850267","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":427.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES MHCF MAC ADDL 15MINS","code_information":[{"code":"2850268","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":213.75,"setting":"both","billing_class":"facility"}]},{"description":"MODERATE SEDATION 15 MHCF","code_information":[{"code":"2850269","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","billing_class":"facility"}]},{"description":"LOCAL NURSE MONITRNG MHCF","code_information":[{"code":"2850270","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":182.75,"setting":"both","billing_class":"facility"}]},{"description":"RF ABLTJ NRV SI JT-MHCF","code_information":[{"code":"2850271","type":"CDM"},{"code":"361","type":"RC"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4807.75,"setting":"both","billing_class":"facility"}]},{"description":"NJX INTERLAMINAR LMBR/SAC-MHCF","code_information":[{"code":"2850272","type":"CDM"},{"code":"361","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"setting":"both","billing_class":"facility"}]},{"description":"NJX AA&/STRD TRIGEMIN NRV-MHCF","code_information":[{"code":"2850273","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.25,"setting":"both","billing_class":"facility"}]},{"description":"DSTRJ NULYT AGT GNCLR NRV-MHCF","code_information":[{"code":"2850274","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4834.0,"setting":"both","billing_class":"facility"}]},{"description":"NB SACR JNT W/GUIDE-MHCF","code_information":[{"code":"2851222","type":"CDM"},{"code":"361","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"NERVOUS SYSTEM UNLIST-MHCF","code_information":[{"code":"2851231","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 1 VISIT EST PT-MHCF","code_information":[{"code":"2851232","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.5,"setting":"both","billing_class":"facility"}]},{"description":"CARPAL TUNNEL INJ-MHCP","code_information":[{"code":"2860011","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON SHEATH/LIGAMNT-MHCP","code_information":[{"code":"2860012","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON ORIGIN/INSERT-MHCP","code_information":[{"code":"2860013","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT 1/2 MISCL-MHCP","code_information":[{"code":"2860014","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT 3 MUSCL-MHCP","code_information":[{"code":"2860015","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ SM JNT/BURS BIL-MHCP","code_information":[{"code":"2860016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":76.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ SM JNT/BURSA-MHCP","code_information":[{"code":"2860017","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ MED JNT/BUR BIL-MHCP","code_information":[{"code":"2860018","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":81.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN/INJ MED JNT/BURSA-MHCP","code_information":[{"code":"2860019","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ LG JNT/BURS BIL-MHCP","code_information":[{"code":"2860020","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":179.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN/INJ LG JNT/BURSA-MHCP","code_information":[{"code":"2860021","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ CRV/THR WO I-MHCP","code_information":[{"code":"2860034","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":187.75,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ CRV/TH W/IMA-MHCP","code_information":[{"code":"2860035","type":"CDM"},{"code":"361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ LUMSAC WO IM-MHCP","code_information":[{"code":"2860036","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ LUMB/SAC W/I-MHCP","code_information":[{"code":"2860037","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"SCS IMPLNT NEUROSTIMULAT-MHCP","code_information":[{"code":"2860040","type":"CDM"},{"code":"361","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":13162.5,"setting":"both","billing_class":"facility"},{"gross_charge":772.25,"setting":"both","billing_class":"professional"}]},{"description":"NB OCCIPITAL BIL-MHCP","code_information":[{"code":"2860047","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":180.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB OCCIPITAL LT-MHCP","code_information":[{"code":"2860048","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":120.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB OCCIPITAL RT-MHCP","code_information":[{"code":"2860049","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":120.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB INTERCOSTAL SINGLE-MHCP","code_information":[{"code":"2860063","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"NB INTERCOSTAL MULTIPLE-MHCP","code_information":[{"code":"2860064","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"NB ILIOINGUIN/ILOHYPOGAST-MHCP","code_information":[{"code":"2860065","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"NB FEMORAL BIL-MHCP","code_information":[{"code":"2860070","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":188.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-MHCP","code_information":[{"code":"2860071","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":125.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-MHCP","code_information":[{"code":"2860072","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":125.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB OTHER PERIPHERAL-MHCP","code_information":[{"code":"2860073","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANSF EPI INJ C/T BIL-MHCP","code_information":[{"code":"2860074","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":370.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ C/T LT-MHCP","code_information":[{"code":"2860075","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":247.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T RT-MHCP","code_information":[{"code":"2860076","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":247.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF WPI INJ C/T AD LT-MHCP","code_information":[{"code":"2860077","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":118.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF WPI INJ C/T AD RT-MHCP","code_information":[{"code":"2860078","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":118.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 LT-MHCP","code_information":[{"code":"2860079","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":210.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 RT-MHCP","code_information":[{"code":"2860080","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":210.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 BI-MHCP","code_information":[{"code":"2860081","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":315.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ L/SAC A RT-MHCP","code_information":[{"code":"2860082","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A LT-MHCP","code_information":[{"code":"2860083","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A BI-MHCP","code_information":[{"code":"2860084","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"FACET CER/THORA LEV 1 BIL-MHCP","code_information":[{"code":"2860085","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":299.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA LEV 1 RT-MHCP","code_information":[{"code":"2860086","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":199.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA LEV 1 LT-MHCP","code_information":[{"code":"2860087","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":199.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THOR L2 ADD BIL-MHCP","code_information":[{"code":"2860088","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":170.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THOR L2 ADD RT-MHCP","code_information":[{"code":"2860089","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":113.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THOR L2 ADD LT-MHCP","code_information":[{"code":"2860090","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":113.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THORA NB L3 BIL-MHCP","code_information":[{"code":"2860091","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":171.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA NB L3 RT-MHCP","code_information":[{"code":"2860092","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":114.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA NB L3 LT-MHCP","code_information":[{"code":"2860093","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":114.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 LT-MHCP","code_information":[{"code":"2860094","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":170.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 RT-MHCP","code_information":[{"code":"2860095","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":170.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SACRAL LI BIL-MHCP","code_information":[{"code":"2860096","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":256.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L2 ADDL RT-MHCP","code_information":[{"code":"2860097","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL LT-MHCP","code_information":[{"code":"2860098","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL BIL-MHCP","code_information":[{"code":"2860099","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":147.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L3 ADDL RT-MHCP","code_information":[{"code":"2860100","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":99.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL LT-MHCP","code_information":[{"code":"2860101","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":99.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL BIL-MHCP","code_information":[{"code":"2860102","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","billing_class":"facility"},{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"SPHENOPALATINE GANGL BL-MHCP","code_information":[{"code":"2860103","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"NB STELLATE GANGLION BIL-MHCP","code_information":[{"code":"2860104","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":210.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB STELLATE GANGLION LT-MHCP","code_information":[{"code":"2860105","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":139.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB STELLATE GANGLION RT-MHCP","code_information":[{"code":"2860106","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":139.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SYMPAT BL THOR/LUMB/CAUD-MHCP","code_information":[{"code":"2860108","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"NB CELIAC PEL INJ-MHCP","code_information":[{"code":"2860109","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV MUSC-MHCP","code_information":[{"code":"2860111","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"setting":"both","billing_class":"facility"},{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT-MHCP","code_information":[{"code":"2860115","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":778.5,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT BIL-MHCP","code_information":[{"code":"2860116","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":6716.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1168.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL BIL-MHCP","code_information":[{"code":"2860117","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":525.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL-MHCP","code_information":[{"code":"2860118","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.5,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT NRV L/S-MHCP","code_information":[{"code":"2860119","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":770.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT NRV L/S BIL-MHCP","code_information":[{"code":"2860120","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6716.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1155.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT N ADDL-MHCP","code_information":[{"code":"2860121","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.5,"setting":"both","billing_class":"facility"},{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT N ADDL BIL-MHCP","code_information":[{"code":"2860122","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":477.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ MJR JNT/BRSA W/US-MHCP","code_information":[{"code":"2860123","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL-MHCP","code_information":[{"code":"2860136","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"SACROILIAC JT INJ BIL-MHCP","code_information":[{"code":"2860160","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ BIL-MHCP","code_information":[{"code":"2860160","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ RT-MHCP","code_information":[{"code":"2860161","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ RT-MHCP","code_information":[{"code":"2860161","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ LT-MHCP","code_information":[{"code":"2860162","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SACROILIAC JT INJ LT-MHCP","code_information":[{"code":"2860162","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"DRN/INJ SM JNT/BUR W/US-MHCP","code_information":[{"code":"2860250","type":"CDM"},{"code":"361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ INT JNT/BUR W/US-MHCP","code_information":[{"code":"2860252","type":"CDM"},{"code":"361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERV FC MSCL-MHCP","code_information":[{"code":"2860256","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK-MHCP","code_information":[{"code":"2860257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 1-4 MUSC-MHCP","code_information":[{"code":"2860258","type":"CDM"},{"code":"361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 1-4 ADDL-MHCP","code_information":[{"code":"2860259","type":"CDM"},{"code":"361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 5/> MUS-MHCP","code_information":[{"code":"2860260","type":"CDM"},{"code":"361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":220.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 5/> ADDL-MHCP","code_information":[{"code":"2860261","type":"CDM"},{"code":"361","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN TRUNK 1-5-MHCP","code_information":[{"code":"2860262","type":"CDM"},{"code":"361","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":217.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN TRUNK 6/>-MHCP","code_information":[{"code":"2860263","type":"CDM"},{"code":"361","type":"RC"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","billing_class":"facility"},{"gross_charge":254.0,"setting":"both","billing_class":"professional"}]},{"description":"TAP BLOCK UNIL INJ-MHCP","code_information":[{"code":"2860264","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.75,"setting":"both","billing_class":"facility"},{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ AA&STRD GENCL NRV-MHCP","code_information":[{"code":"2860265","type":"CDM"},{"code":"361","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"RF ABLTJ NRV SI JT-MHCP","code_information":[{"code":"2860271","type":"CDM"},{"code":"361","type":"RC"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4034.25,"setting":"both","billing_class":"facility"},{"gross_charge":365.25,"setting":"both","billing_class":"professional"}]},{"description":"NJX INTERLAMINAR LMBR/SAC-MHCP","code_information":[{"code":"2860272","type":"CDM"},{"code":"361","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1891.25,"setting":"both","billing_class":"facility"},{"gross_charge":462.25,"setting":"both","billing_class":"professional"}]},{"description":"NJX AA&/STRD TRIGEMIN NRV-MHCP","code_information":[{"code":"2860273","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.25,"setting":"both","billing_class":"facility"},{"gross_charge":213.25,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ NULYT AGT GNCLR NRV-MHCP","code_information":[{"code":"2860274","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4034.25,"setting":"both","billing_class":"facility"},{"gross_charge":273.5,"setting":"both","billing_class":"professional"}]},{"description":"NB SACR JNT W/GUIDE-MHCP","code_information":[{"code":"2861222","type":"CDM"},{"code":"361","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.75,"setting":"both","billing_class":"facility"},{"gross_charge":391.75,"setting":"both","billing_class":"professional"}]},{"description":"NERVOUS SYSTEM UNLIST PRC-MHCP","code_information":[{"code":"2861231","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":661.75,"setting":"both","billing_class":"professional"}]},{"description":"BR EMOTIONAL/BEH ASSM-MHCP","code_information":[{"code":"2861233","type":"CDM"},{"code":"519","type":"RC"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"BR EMOTIONAL/BEH ASSM-MHCP","code_information":[{"code":"2861233","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"facility"}]},{"description":"FNA W/O IMAGE-MMA","code_information":[{"code":"2900010","type":"CDM"},{"code":"510","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF SKIN ABSCESS-MMA","code_information":[{"code":"2900014","type":"CDM"},{"code":"510","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM FOREIGN BODY;SIMPLE-MMA","code_information":[{"code":"2900015","type":"CDM"},{"code":"510","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ACNE SURGERY-MMA","code_information":[{"code":"2900016","type":"CDM"},{"code":"510","type":"RC"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PILONIDAL CYST;SIMPL-MMA","code_information":[{"code":"2900017","type":"CDM"},{"code":"510","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM FOREIGN BODY;COMPLEX-MMA","code_information":[{"code":"2900018","type":"CDM"},{"code":"510","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1733.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF SKIN ABSCESS-MMA","code_information":[{"code":"2900019","type":"CDM"},{"code":"510","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN PILONIDAL CYST;COMP-MMA","code_information":[{"code":"2900028","type":"CDM"},{"code":"510","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1314.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN HEMATOMA/FLUID-MMA","code_information":[{"code":"2900037","type":"CDM"},{"code":"510","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PUNCTURE DRAINAGE OF LES-MMA","code_information":[{"code":"2900040","type":"CDM"},{"code":"510","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEBRIDE INFECTED SKIN-MMA","code_information":[{"code":"2900043","type":"CDM"},{"code":"510","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEBRIDE SKIN/TISSUE-MMA","code_information":[{"code":"2900046","type":"CDM"},{"code":"510","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEB SUBQ TISSUE ADD-ON-MMA","code_information":[{"code":"2900055","type":"CDM"},{"code":"510","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TRIM SKIN LESION-MMA","code_information":[{"code":"2900058","type":"CDM"},{"code":"510","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TRIM SKIN LESIONS  2 TO 4-MMA","code_information":[{"code":"2900061","type":"CDM"},{"code":"510","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TRIM SKIN LESIONS  OVER 4-MMA","code_information":[{"code":"2900064","type":"CDM"},{"code":"510","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF SKIN TAGS-MMA","code_information":[{"code":"2900073","type":"CDM"},{"code":"510","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM SKIN TAGS ADD-ON-MMA","code_information":[{"code":"2900076","type":"CDM"},{"code":"510","type":"RC"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900079","type":"CDM"},{"code":"510","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900082","type":"CDM"},{"code":"510","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900085","type":"CDM"},{"code":"510","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900088","type":"CDM"},{"code":"510","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900091","type":"CDM"},{"code":"510","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900094","type":"CDM"},{"code":"510","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900097","type":"CDM"},{"code":"510","type":"RC"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900100","type":"CDM"},{"code":"510","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900103","type":"CDM"},{"code":"510","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE SKIN LESION-MMA","code_information":[{"code":"2900106","type":"CDM"},{"code":"510","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 0.5 < CM-MMA","code_information":[{"code":"2900109","type":"CDM"},{"code":"510","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 0.6-1 CM-MMA","code_information":[{"code":"2900112","type":"CDM"},{"code":"510","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 1.1-2 CM-MMA","code_information":[{"code":"2900115","type":"CDM"},{"code":"510","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 2.1-3 CM-MMA","code_information":[{"code":"2900118","type":"CDM"},{"code":"510","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 3.1-4 CM-MMA","code_information":[{"code":"2900121","type":"CDM"},{"code":"510","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT B9 > 4.0 CM-MMA","code_information":[{"code":"2900124","type":"CDM"},{"code":"510","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2007.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H-F-NK-SP B9 0.5 <-MMA","code_information":[{"code":"2900127","type":"CDM"},{"code":"510","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1667.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H-F-NK-SP B9 0.6-1-MMA","code_information":[{"code":"2900130","type":"CDM"},{"code":"510","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H-F-NK-SP B9 1.1-2-MMA","code_information":[{"code":"2900133","type":"CDM"},{"code":"510","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H-F-NK-SP B9 2.1-3-MMA","code_information":[{"code":"2900136","type":"CDM"},{"code":"510","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H-F-NK-SP B9 3.1-4-MMA","code_information":[{"code":"2900139","type":"CDM"},{"code":"510","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM B9 0.5<CM-MMA","code_information":[{"code":"2900142","type":"CDM"},{"code":"510","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM B9 0.6-1CM-MMA","code_information":[{"code":"2900145","type":"CDM"},{"code":"510","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM B9 1.1-2CM-MMA","code_information":[{"code":"2900148","type":"CDM"},{"code":"510","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM B9 2.1-3CM-MMA","code_information":[{"code":"2900151","type":"CDM"},{"code":"510","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":1867.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM B9 3.1-4CM-MMA","code_information":[{"code":"2900154","type":"CDM"},{"code":"510","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG 0.5<CM-MMA","code_information":[{"code":"2900157","type":"CDM"},{"code":"510","type":"RC"},{"code":"11600","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG 0.6-1CM-MMA","code_information":[{"code":"2900160","type":"CDM"},{"code":"510","type":"RC"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG 1.1-2CM-MMA","code_information":[{"code":"2900163","type":"CDM"},{"code":"510","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG 2.1-3CM-MMA","code_information":[{"code":"2900166","type":"CDM"},{"code":"510","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1415.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG 3.1-4CM-MMA","code_information":[{"code":"2900169","type":"CDM"},{"code":"510","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1454.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TR EXT MLG > 4 CM-MMA","code_information":[{"code":"2900172","type":"CDM"},{"code":"510","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC H/F/NK/SP MAL .5<-MMA","code_information":[{"code":"2900174","type":"CDM"},{"code":"510","type":"RC"},{"code":"11620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.75,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/N/S MLG 0.6-1-MMA","code_information":[{"code":"2900175","type":"CDM"},{"code":"510","type":"RC"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H/F/N/S MLG 1.1-2-MMA","code_information":[{"code":"2900178","type":"CDM"},{"code":"510","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC S/N/H/F/G MLG 2.1-3-MMA","code_information":[{"code":"2900179","type":"CDM"},{"code":"510","type":"RC"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":2048.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC S/N/H/F/G MAL 3.1-4-MMA","code_information":[{"code":"2900180","type":"CDM"},{"code":"510","type":"RC"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2090.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX H/F/N/S MLG > 4 CM-MMA","code_information":[{"code":"2900181","type":"CDM"},{"code":"510","type":"RC"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":3591.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM MALIG 0.6-1-MMA","code_information":[{"code":"2900184","type":"CDM"},{"code":"510","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM MALIG 1.1-2-MMA","code_information":[{"code":"2900187","type":"CDM"},{"code":"510","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM MALIG 2.1-3-MMA","code_information":[{"code":"2900190","type":"CDM"},{"code":"510","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":2069.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FC-MM MALIG 3.1-4-MMA","code_information":[{"code":"2900193","type":"CDM"},{"code":"510","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":2145.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FACE-MM MLG > 4 CM-MMA","code_information":[{"code":"2900196","type":"CDM"},{"code":"510","type":"RC"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":3765.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TRIM NAIL-MMA","code_information":[{"code":"2900199","type":"CDM"},{"code":"510","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEBRIDE NAIL  1-5-MMA","code_information":[{"code":"2900202","type":"CDM"},{"code":"510","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEBRIDE NAIL  6 OR MORE-MMA","code_information":[{"code":"2900205","type":"CDM"},{"code":"510","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NAIL PLATE-MMA","code_information":[{"code":"2900208","type":"CDM"},{"code":"510","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM NAIL PLATE  ADD-ON-MMA","code_information":[{"code":"2900211","type":"CDM"},{"code":"510","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN BL FR UNDER NAIL-MMA","code_information":[{"code":"2900214","type":"CDM"},{"code":"510","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF NAIL BED-MMA","code_information":[{"code":"2900217","type":"CDM"},{"code":"510","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX OF NAIL FOLD  TOE-MMA","code_information":[{"code":"2900220","type":"CDM"},{"code":"510","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJECT INTO SKIN LESIONS-MMA","code_information":[{"code":"2900223","type":"CDM"},{"code":"510","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF CONTRACEPTIVE CAP-MMA","code_information":[{"code":"2900226","type":"CDM"},{"code":"510","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INSERT DRUG IMPL DEVICE-MMA","code_information":[{"code":"2900229","type":"CDM"},{"code":"510","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM DRUG IMPLANT DEVICE-MMA","code_information":[{"code":"2900232","type":"CDM"},{"code":"510","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM/INSERT DRUG IMPLANT-MMA","code_information":[{"code":"2900235","type":"CDM"},{"code":"510","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-MMA","code_information":[{"code":"2900238","type":"CDM"},{"code":"510","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPAIR SUPERFICIAL WOUND-MMA","code_information":[{"code":"2900241","type":"CDM"},{"code":"510","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPAIR SUPERFICIAL WOUND-MMA","code_information":[{"code":"2900244","type":"CDM"},{"code":"510","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPAIR SUPERFICIAL WOUND-MMA","code_information":[{"code":"2900247","type":"CDM"},{"code":"510","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPAIR SUPERFICIAL WOUND-MMA","code_information":[{"code":"2900250","type":"CDM"},{"code":"510","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CLOSURE OF SPLIT WOUND-MMA","code_information":[{"code":"2900253","type":"CDM"},{"code":"510","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND 2.5CM/<-MMA","code_information":[{"code":"2900259","type":"CDM"},{"code":"510","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND 2.6-7.5CM-MMA","code_information":[{"code":"2900262","type":"CDM"},{"code":"510","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND 7.6-12.5CM-MMA","code_information":[{"code":"2900265","type":"CDM"},{"code":"510","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND 2.6-7.5CM-MMA","code_information":[{"code":"2900268","type":"CDM"},{"code":"510","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND FACE 2.5CM/<-MMA","code_information":[{"code":"2900271","type":"CDM"},{"code":"510","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTMD RPR WND FACE 2.6-5CM-MMA","code_information":[{"code":"2900274","type":"CDM"},{"code":"510","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SKIN SUB GR TRNK/ARM/LEG-MMA","code_information":[{"code":"2900277","type":"CDM"},{"code":"510","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2040.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR T/A/L ADDL-MMA","code_information":[{"code":"2900280","type":"CDM"},{"code":"510","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR FACE/NK/HF/G-MMA","code_information":[{"code":"2900283","type":"CDM"},{"code":"510","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SKIN SUB GR F/N/H/G ADDL-MMA","code_information":[{"code":"2900286","type":"CDM"},{"code":"510","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL TREAT OF BURN-MMA","code_information":[{"code":"2900289","type":"CDM"},{"code":"510","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRESS/DEBRID P/THICK BURN-MMA","code_information":[{"code":"2900292","type":"CDM"},{"code":"510","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRESS/DEBRID BURN  M-MMA","code_information":[{"code":"2900295","type":"CDM"},{"code":"510","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRESS/DEBRID BURN  L-MMA","code_information":[{"code":"2900298","type":"CDM"},{"code":"510","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY BNGN/PREMLG LES-MMA","code_information":[{"code":"2900302","type":"CDM"},{"code":"510","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY LESIONS  2-14-MMA","code_information":[{"code":"2900305","type":"CDM"},{"code":"510","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY LESIONS  15&>-MMA","code_information":[{"code":"2900308","type":"CDM"},{"code":"510","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTRUCT OF SKIN LESIONS-MMA","code_information":[{"code":"2900311","type":"CDM"},{"code":"510","type":"RC"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LESION  1-14-MMA","code_information":[{"code":"2900314","type":"CDM"},{"code":"510","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY LESIONS  15&>-MMA","code_information":[{"code":"2900317","type":"CDM"},{"code":"510","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CHEMICAL CAUTERY  TISSUE-MMA","code_information":[{"code":"2900320","type":"CDM"},{"code":"510","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTRUCT OF SKIN LESIONS-MMA","code_information":[{"code":"2900323","type":"CDM"},{"code":"510","type":"RC"},{"code":"17262","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTRUCT OF SKIN LESIONS-MMA","code_information":[{"code":"2900326","type":"CDM"},{"code":"510","type":"RC"},{"code":"17281","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CRYOTHERAPY OF SKIN-MMA","code_information":[{"code":"2900329","type":"CDM"},{"code":"510","type":"RC"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF BREAST LESION-MMA","code_information":[{"code":"2900332","type":"CDM"},{"code":"510","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.5,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST 1ST LES US IMAG-MMA","code_information":[{"code":"2900335","type":"CDM"},{"code":"510","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"setting":"both","billing_class":"professional"}]},{"description":"BX BRST PERCUT W/O IMAGE-MMA","code_information":[{"code":"2900338","type":"CDM"},{"code":"510","type":"RC"},{"code":"19100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF BREAST OPEN-MMA","code_information":[{"code":"2900341","type":"CDM"},{"code":"510","type":"RC"},{"code":"19101","type":"HCPCS"}],"standard_charges":[{"gross_charge":3578.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF BREAST LESION-MMA","code_information":[{"code":"2900344","type":"CDM"},{"code":"510","type":"RC"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3907.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ PLATELET PLASMA-MMA","code_information":[{"code":"2900500","type":"CDM"},{"code":"260","type":"RC"},{"code":"0232T","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.25,"setting":"both","billing_class":"facility"},{"gross_charge":404.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY COMPRS LWR LEG BIL-MMA","code_information":[{"code":"2900501","type":"CDM"},{"code":"510","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED ALL/IMMLG SVC/PX-MMA","code_information":[{"code":"2900503","type":"CDM"},{"code":"510","type":"RC"},{"code":"95199","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR NSL VLV CLPSE W/RMDL-MMA","code_information":[{"code":"2900504","type":"CDM"},{"code":"510","type":"RC"},{"code":"30469","type":"HCPCS"}],"standard_charges":[{"gross_charge":8527.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER 2 VIEW LT-MMA","code_information":[{"code":"2900505","type":"CDM"},{"code":"510","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY ELBOW 3 VIEW LT-MMA","code_information":[{"code":"2900506","type":"CDM"},{"code":"510","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY WRIST 3 VIEW LT-MMA","code_information":[{"code":"2900507","type":"CDM"},{"code":"510","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HAND 3 VIEW LT-MMA","code_information":[{"code":"2900508","type":"CDM"},{"code":"510","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HIP 2-3 VIEW LT-MMA","code_information":[{"code":"2900509","type":"CDM"},{"code":"510","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NEUROMUSCULAR JUNCTION TST-MMA","code_information":[{"code":"2900510","type":"CDM"},{"code":"510","type":"RC"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED NERVOUS SYSTEM PX-MMA","code_information":[{"code":"2900511","type":"CDM"},{"code":"510","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"PSYCHOPHYSIOLOGICAL THERAP-MMA","code_information":[{"code":"2900512","type":"CDM"},{"code":"510","type":"RC"},{"code":"90875","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC NEUROFIBROM CUT NRV-MMA","code_information":[{"code":"2900513","type":"CDM"},{"code":"510","type":"RC"},{"code":"64788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2427.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC TUMOR ABD LES SC 3CM/>-MMA","code_information":[{"code":"2900514","type":"CDM"},{"code":"510","type":"RC"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.75,"setting":"both","billing_class":"professional"}]},{"description":"SPINE SINGLE VIEW-MMA","code_information":[{"code":"2900515","type":"CDM"},{"code":"510","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"setting":"both","billing_class":"professional"}]},{"description":"OB US DETAILED SNGL FETUS-MMA","code_information":[{"code":"2900516","type":"CDM"},{"code":"510","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.25,"setting":"both","billing_class":"professional"}]},{"description":"OB US BIOPH PROF W/NST-MMA","code_information":[{"code":"2900517","type":"CDM"},{"code":"510","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/STIM 15MIN-MMA","code_information":[{"code":"2900518","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97813","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/STIM ADDL 15MIN-MMA","code_information":[{"code":"2900519","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97814","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYTX COMPLEX INTERACTIVE-MMA","code_information":[{"code":"2900520","type":"CDM"},{"code":"510","type":"RC"},{"code":"90785","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.75,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JNT/BRSA WO US BIL-MMA","code_information":[{"code":"2900521","type":"CDM"},{"code":"510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTOSCOPY REMOVAL/CLOTS-MMA","code_information":[{"code":"2900522","type":"CDM"},{"code":"510","type":"RC"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4008.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF FORGEIN BODY-MMA","code_information":[{"code":"2900523","type":"CDM"},{"code":"510","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1903.5,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPCT WAX W/TOOL BIL-MMA","code_information":[{"code":"2900524","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EX ARM/ELBW TUM DEEP 5CM/>-MMA","code_information":[{"code":"2900525","type":"CDM"},{"code":"510","type":"RC"},{"code":"24073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3694.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX ARM/ELBOW TUM DEEP <5CM-MMA","code_information":[{"code":"2900526","type":"CDM"},{"code":"510","type":"RC"},{"code":"24076","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FOREARM TUM DEEP 3CM/>-MMA","code_information":[{"code":"2900527","type":"CDM"},{"code":"510","type":"RC"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3519.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FOREARM TUM DEEP <3CM-MMA","code_information":[{"code":"2900528","type":"CDM"},{"code":"510","type":"RC"},{"code":"25076","type":"HCPCS"}],"standard_charges":[{"gross_charge":2244.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC HIP/PELV TUM DEEP 5CM/>MMA","code_information":[{"code":"2900529","type":"CDM"},{"code":"510","type":"RC"},{"code":"27045","type":"HCPCS"}],"standard_charges":[{"gross_charge":3742.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC HIP/PELV LES SC < 3CM-MMA","code_information":[{"code":"2900530","type":"CDM"},{"code":"510","type":"RC"},{"code":"27047","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC HIP/PELV TUM DEEP <5CM-MMA","code_information":[{"code":"2900531","type":"CDM"},{"code":"510","type":"RC"},{"code":"27048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC THGH/KNEE TUM DEP <5CM-MMA","code_information":[{"code":"2900532","type":"CDM"},{"code":"510","type":"RC"},{"code":"27328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3617.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC THGH/KNEE TUM DEP 5CM/>MMA","code_information":[{"code":"2900533","type":"CDM"},{"code":"510","type":"RC"},{"code":"27339","type":"HCPCS"}],"standard_charges":[{"gross_charge":3761.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC LEG/ANKLE TUM < 3CM-MMA","code_information":[{"code":"2900534","type":"CDM"},{"code":"510","type":"RC"},{"code":"27618","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC LEG/ANKLE TUM DEP <5CM-MMA","code_information":[{"code":"2900535","type":"CDM"},{"code":"510","type":"RC"},{"code":"27619","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC LEG/ANKLE LES SC 3CM/>-MMA","code_information":[{"code":"2900536","type":"CDM"},{"code":"510","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC LEG/ANKLE TUM DEP 5CM/>MMA","code_information":[{"code":"2900537","type":"CDM"},{"code":"510","type":"RC"},{"code":"27634","type":"HCPCS"}],"standard_charges":[{"gross_charge":3675.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FOOT/TOE TUM SC 1.5CM/>MMA","code_information":[{"code":"2900538","type":"CDM"},{"code":"510","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FT/TOE TUM DEP 1.5CM/>MMA","code_information":[{"code":"2900539","type":"CDM"},{"code":"510","type":"RC"},{"code":"28041","type":"HCPCS"}],"standard_charges":[{"gross_charge":3420.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FOOT/TOE TUM SC <1.5CM-MMA","code_information":[{"code":"2900540","type":"CDM"},{"code":"510","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FOOT/TOE TUM DEP<1.5CM-MMA","code_information":[{"code":"2900541","type":"CDM"},{"code":"510","type":"RC"},{"code":"28045","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC FACE TUM DEEP 2 CM/>-MMA","code_information":[{"code":"2900542","type":"CDM"},{"code":"510","type":"RC"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":3501.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC NECK TUM DEEP 5CM/>-MMA","code_information":[{"code":"2900543","type":"CDM"},{"code":"510","type":"RC"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":3737.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC NECK TUM DEEP < 5CM-MMA","code_information":[{"code":"2900544","type":"CDM"},{"code":"510","type":"RC"},{"code":"21556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC BACK TUM DEEP 5CM/>-MMA","code_information":[{"code":"2900545","type":"CDM"},{"code":"510","type":"RC"},{"code":"21933","type":"HCPCS"}],"standard_charges":[{"gross_charge":3746.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP < 5CM-MMA","code_information":[{"code":"2900546","type":"CDM"},{"code":"510","type":"RC"},{"code":"22900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3554.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP 5CM/>-MMA","code_information":[{"code":"2900547","type":"CDM"},{"code":"510","type":"RC"},{"code":"22901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3666.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABD LES SC < 3CM-MMA","code_information":[{"code":"2900548","type":"CDM"},{"code":"510","type":"RC"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE LUNG CATHETER-MMA","code_information":[{"code":"2900549","type":"CDM"},{"code":"510","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.75,"setting":"both","billing_class":"professional"}]},{"description":"EXCISION OF PENIS LESION-MMA","code_information":[{"code":"2900550","type":"CDM"},{"code":"510","type":"RC"},{"code":"54060","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF MISCARRIAGE-MMA","code_information":[{"code":"2900551","type":"CDM"},{"code":"510","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.75,"setting":"both","billing_class":"professional"}]},{"description":"CLN OUT MASTOID CAVITY BIL-MMA","code_information":[{"code":"2900552","type":"CDM"},{"code":"510","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"RECONSTRUCT EXTRA FINGER-MMA","code_information":[{"code":"2900554","type":"CDM"},{"code":"510","type":"RC"},{"code":"26587","type":"HCPCS"}],"standard_charges":[{"gross_charge":4483.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL PEEL NONFACIAL-MMA","code_information":[{"code":"2900555","type":"CDM"},{"code":"510","type":"RC"},{"code":"15792","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"setting":"both","billing_class":"professional"}]},{"description":"N BLCK INJ PLNTR DIGIT BIL-MMA","code_information":[{"code":"2900556","type":"CDM"},{"code":"510","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CHEMICAL PEEL FACE EPIDERM-MMA","code_information":[{"code":"2900557","type":"CDM"},{"code":"510","type":"RC"},{"code":"15788","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.25,"setting":"both","billing_class":"professional"}]},{"description":"FILLETED FINGER/TOE FLAP-MMA","code_information":[{"code":"2900558","type":"CDM"},{"code":"510","type":"RC"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2614.0,"setting":"both","billing_class":"professional"}]},{"description":"GENETIC COUNSELING 30MIN-MMA","code_information":[{"code":"2900559","type":"CDM"},{"code":"519","type":"RC"},{"code":"96041","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.5,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT OF ANKLE FX-MMA","code_information":[{"code":"2900560","type":"CDM"},{"code":"510","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE BENDING-MMA","code_information":[{"code":"2900561","type":"CDM"},{"code":"510","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY THORACIC SPINE 3V-MMA","code_information":[{"code":"2900562","type":"CDM"},{"code":"510","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 15M-MMA","code_information":[{"code":"2900563","type":"CDM"},{"code":"510","type":"RC"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 30M-MMA","code_information":[{"code":"2900564","type":"CDM"},{"code":"510","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 45M-MMA","code_information":[{"code":"2900565","type":"CDM"},{"code":"510","type":"RC"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 1HR-MMA","code_information":[{"code":"2900566","type":"CDM"},{"code":"510","type":"RC"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.75,"setting":"both","billing_class":"professional"}]},{"description":"REM WAX W/AUDIO TEST-MMA","code_information":[{"code":"2900567","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0268","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.75,"setting":"both","billing_class":"professional"}]},{"description":"THER INJ  CARP TUNNEL-MMA","code_information":[{"code":"2900600","type":"CDM"},{"code":"510","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ TENDON SHEATH/LIGAM-MMA","code_information":[{"code":"2900603","type":"CDM"},{"code":"510","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ TENDON ORIGIN/INSERT-MMA","code_information":[{"code":"2900606","type":"CDM"},{"code":"510","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ TRIG PNT  1/2 MUSCL-MMA","code_information":[{"code":"2900609","type":"CDM"},{"code":"510","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ TRIG PNTS  =/> 3-MMA","code_information":[{"code":"2900612","type":"CDM"},{"code":"510","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN/INJECT  JOINT/BURSA-MMA","code_information":[{"code":"2900615","type":"CDM"},{"code":"510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN/INJECT JOINT/BURSA-MMA","code_information":[{"code":"2900618","type":"CDM"},{"code":"510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN/INJECT JOINT/BURSA-MMA","code_information":[{"code":"2900621","type":"CDM"},{"code":"510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN/INJ JNT/BURSA W/US-MMA","code_information":[{"code":"2900624","type":"CDM"},{"code":"510","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"professional"}]},{"description":"ASP/INJ GANGLION CYST-MMA","code_information":[{"code":"2900627","type":"CDM"},{"code":"510","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF IMPLANT SUPERFICIAL-MMA","code_information":[{"code":"2900630","type":"CDM"},{"code":"510","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX TUMOR/FC/SC SUBQ >2CM-MMA","code_information":[{"code":"2900633","type":"CDM"},{"code":"510","type":"RC"},{"code":"21012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2210.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX FACE TUM DEEP < 2 CM-MMA","code_information":[{"code":"2900636","type":"CDM"},{"code":"510","type":"RC"},{"code":"21013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN NECK/CHEST LESION-MMA","code_information":[{"code":"2900642","type":"CDM"},{"code":"510","type":"RC"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":3252.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX LES NCK/CHST SQ >3CM-MMA","code_information":[{"code":"2900645","type":"CDM"},{"code":"510","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.25,"setting":"both","billing_class":"professional"}]},{"description":"REM LES NCK/CHST SQ<3CM-MMA","code_information":[{"code":"2900648","type":"CDM"},{"code":"510","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2108.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT STERNUM FX-MMA","code_information":[{"code":"2900651","type":"CDM"},{"code":"510","type":"RC"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.25,"setting":"both","billing_class":"professional"}]},{"description":"REM LES BACK/FLANK <3CM-MMA","code_information":[{"code":"2900654","type":"CDM"},{"code":"510","type":"RC"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2210.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM LES BACK/FLANK >3CM-MMA","code_information":[{"code":"2900657","type":"CDM"},{"code":"510","type":"RC"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":2429.25,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUM DEEP < 5 CM-MMA","code_information":[{"code":"2900660","type":"CDM"},{"code":"510","type":"RC"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SPINE FX-MMA","code_information":[{"code":"2900663","type":"CDM"},{"code":"510","type":"RC"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM SHOULDER LESION >3CM-MMA","code_information":[{"code":"2900666","type":"CDM"},{"code":"510","type":"RC"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2861.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT CLAVICLE FX-MMA","code_information":[{"code":"2900669","type":"CDM"},{"code":"510","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT CLAVICLE DISLOC-MMA","code_information":[{"code":"2900672","type":"CDM"},{"code":"510","type":"RC"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SHOULDER BLADE FX-MMA","code_information":[{"code":"2900675","type":"CDM"},{"code":"510","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900678","type":"CDM"},{"code":"510","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900681","type":"CDM"},{"code":"510","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT SHOULDER DISLOC-MMA","code_information":[{"code":"2900684","type":"CDM"},{"code":"510","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM ARM/ELBOW LES >3CM-MMA","code_information":[{"code":"2900687","type":"CDM"},{"code":"510","type":"RC"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900690","type":"CDM"},{"code":"510","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900693","type":"CDM"},{"code":"510","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900696","type":"CDM"},{"code":"510","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HUMERUS FX-MMA","code_information":[{"code":"2900699","type":"CDM"},{"code":"510","type":"RC"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ELBOW DISLOCATION-MMA","code_information":[{"code":"2900702","type":"CDM"},{"code":"510","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS FX-MMA","code_information":[{"code":"2900705","type":"CDM"},{"code":"510","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT ULNAR FX-MMA","code_information":[{"code":"2900708","type":"CDM"},{"code":"510","type":"RC"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM FOREARM LES SUBC>3CM-MMA","code_information":[{"code":"2900711","type":"CDM"},{"code":"510","type":"RC"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2280.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM LES SUBC<3CM-MMA","code_information":[{"code":"2900714","type":"CDM"},{"code":"510","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2118.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX OF RADIUS-MMA","code_information":[{"code":"2900717","type":"CDM"},{"code":"510","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX OF ULNA-MMA","code_information":[{"code":"2900720","type":"CDM"},{"code":"510","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX RADIUS & ULNA-MMA","code_information":[{"code":"2900723","type":"CDM"},{"code":"510","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX RADIUS & ULNA-MMA","code_information":[{"code":"2900726","type":"CDM"},{"code":"510","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2296.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX RADIUS/ULNA-MMA","code_information":[{"code":"2900729","type":"CDM"},{"code":"510","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX RADIUS/ULNA-MMA","code_information":[{"code":"2900732","type":"CDM"},{"code":"510","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2368.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT WRIST BONE FX-MMA","code_information":[{"code":"2900735","type":"CDM"},{"code":"510","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT WRIST BONE FX-MMA","code_information":[{"code":"2900738","type":"CDM"},{"code":"510","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT WRIST BONE FX-MMA","code_information":[{"code":"2900741","type":"CDM"},{"code":"510","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF FINGER ABSC-MMA","code_information":[{"code":"2900744","type":"CDM"},{"code":"510","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT METACARPAL FX-MMA","code_information":[{"code":"2900747","type":"CDM"},{"code":"510","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT METACARPAL FX-MMA","code_information":[{"code":"2900750","type":"CDM"},{"code":"510","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FINGER FX  EACH-MMA","code_information":[{"code":"2900753","type":"CDM"},{"code":"510","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FINGER FX  EACH-MMA","code_information":[{"code":"2900756","type":"CDM"},{"code":"510","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FINGER FX  EACH-MMA","code_information":[{"code":"2900759","type":"CDM"},{"code":"510","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FINGER FX  EACH-MMA","code_information":[{"code":"2900762","type":"CDM"},{"code":"510","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FINGER DISLOCATION-MMA","code_information":[{"code":"2900765","type":"CDM"},{"code":"510","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX HIP PELVIS LES SC>3CM-MMA","code_information":[{"code":"2900768","type":"CDM"},{"code":"510","type":"RC"},{"code":"27043","type":"HCPCS"}],"standard_charges":[{"gross_charge":3497.0,"setting":"both","billing_class":"professional"}]},{"description":"CLSD TX PELVIC RING FX-MMA","code_information":[{"code":"2900771","type":"CDM"},{"code":"510","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TAIL BONE FX-MMA","code_information":[{"code":"2900774","type":"CDM"},{"code":"510","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HIP SOCKET FX-MMA","code_information":[{"code":"2900777","type":"CDM"},{"code":"510","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-MMA","code_information":[{"code":"2900780","type":"CDM"},{"code":"510","type":"RC"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT THIGH FX-MMA","code_information":[{"code":"2900783","type":"CDM"},{"code":"510","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT HIP DISLOCATION-MMA","code_information":[{"code":"2900786","type":"CDM"},{"code":"510","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX OF THIGH FX-MMA","code_information":[{"code":"2900789","type":"CDM"},{"code":"510","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":3709.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES >3CM-MMA","code_information":[{"code":"2900792","type":"CDM"},{"code":"510","type":"RC"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":3173.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF THIGH FX-MMA","code_information":[{"code":"2900795","type":"CDM"},{"code":"510","type":"RC"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF THIGH FX-MMA","code_information":[{"code":"2900798","type":"CDM"},{"code":"510","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF THIGH FX-MMA","code_information":[{"code":"2900801","type":"CDM"},{"code":"510","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF THIGH FX-MMA","code_information":[{"code":"2900804","type":"CDM"},{"code":"510","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2669.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT KNEECAP FX-MMA","code_information":[{"code":"2900807","type":"CDM"},{"code":"510","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT KNEE FX-MMA","code_information":[{"code":"2900810","type":"CDM"},{"code":"510","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT KNEE FX-MMA","code_information":[{"code":"2900813","type":"CDM"},{"code":"510","type":"RC"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF TIBIA FX-MMA","code_information":[{"code":"2900816","type":"CDM"},{"code":"510","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF ANKLE FX-MMA","code_information":[{"code":"2900819","type":"CDM"},{"code":"510","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CLTX POST ANKLE FX-MMA","code_information":[{"code":"2900822","type":"CDM"},{"code":"510","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF FIBULA FX-MMA","code_information":[{"code":"2900825","type":"CDM"},{"code":"510","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF ANKLE FX-MMA","code_information":[{"code":"2900828","type":"CDM"},{"code":"510","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF ANKLE FX-MMA","code_information":[{"code":"2900831","type":"CDM"},{"code":"510","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF ANKLE FX-MMA","code_information":[{"code":"2900834","type":"CDM"},{"code":"510","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT LOWER LEG FX-MMA","code_information":[{"code":"2900837","type":"CDM"},{"code":"510","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT FOREIGN BODY-MMA","code_information":[{"code":"2900840","type":"CDM"},{"code":"510","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1315.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF HEEL FX-MMA","code_information":[{"code":"2900843","type":"CDM"},{"code":"510","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF ANKLE FX-MMA","code_information":[{"code":"2900846","type":"CDM"},{"code":"510","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT MIDFOOT FX  EACH-MMA","code_information":[{"code":"2900849","type":"CDM"},{"code":"510","type":"RC"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METATARSAL FX-MMA","code_information":[{"code":"2900852","type":"CDM"},{"code":"510","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT BIG TOE FX-MMA","code_information":[{"code":"2900855","type":"CDM"},{"code":"510","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF TOE FX-MMA","code_information":[{"code":"2900858","type":"CDM"},{"code":"510","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF TOE FX-MMA","code_information":[{"code":"2900861","type":"CDM"},{"code":"510","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT SESAMOID BONE FX-MMA","code_information":[{"code":"2900864","type":"CDM"},{"code":"510","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TOE DISLOCATION-MMA","code_information":[{"code":"2900867","type":"CDM"},{"code":"510","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF LONG ARM CAST-MMA","code_information":[{"code":"2900870","type":"CDM"},{"code":"510","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY OF FOREARM CAST-MMA","code_information":[{"code":"2900873","type":"CDM"},{"code":"510","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY HAND/WRIST CAST-MMA","code_information":[{"code":"2900876","type":"CDM"},{"code":"510","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY LONG ARM SPLINT-MMA","code_information":[{"code":"2900879","type":"CDM"},{"code":"510","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY FOREARM SPLINT-MMA","code_information":[{"code":"2900882","type":"CDM"},{"code":"510","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY OF FINGER SPLINT-MMA","code_information":[{"code":"2900885","type":"CDM"},{"code":"510","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY OF LONG LEG CAST-MMA","code_information":[{"code":"2900889","type":"CDM"},{"code":"510","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY OF LONG LEG CAST-MMA","code_information":[{"code":"2900892","type":"CDM"},{"code":"510","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY SHORT LEG CAST-MMA","code_information":[{"code":"2900895","type":"CDM"},{"code":"510","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY SHORT LEG CAST-MMA","code_information":[{"code":"2900898","type":"CDM"},{"code":"510","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY SHORT LEG CAST-MMA","code_information":[{"code":"2900901","type":"CDM"},{"code":"510","type":"RC"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY  LONG LEG SPLINT-MMA","code_information":[{"code":"2900904","type":"CDM"},{"code":"510","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY LOWER LEG SPLINT-MMA","code_information":[{"code":"2900907","type":"CDM"},{"code":"510","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"STRAPPING ANKLE AND/OR FT-MMA","code_information":[{"code":"2900910","type":"CDM"},{"code":"510","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY OF PASTE BOOT-MMA","code_information":[{"code":"2900913","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"APPLY COMPRS LWR LEG-MMA","code_information":[{"code":"2900916","type":"CDM"},{"code":"510","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVISION OF CAST-MMA","code_information":[{"code":"2900919","type":"CDM"},{"code":"510","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM/REVISION OF CAST-MMA","code_information":[{"code":"2900922","type":"CDM"},{"code":"510","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WINDOWING OF CAST-MMA","code_information":[{"code":"2900925","type":"CDM"},{"code":"510","type":"RC"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WEDGING OF CAST-MMA","code_information":[{"code":"2900928","type":"CDM"},{"code":"510","type":"RC"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CASTING/STRAPPING-MMA","code_information":[{"code":"2900931","type":"CDM"},{"code":"510","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INTRANASAL BX-MMA","code_information":[{"code":"2901200","type":"CDM"},{"code":"510","type":"RC"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF NOSE POLYP-MMA","code_information":[{"code":"2901203","type":"CDM"},{"code":"510","type":"RC"},{"code":"30110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.75,"setting":"both","billing_class":"professional"}]},{"description":"REM NASAL FOREIGN BODY-MMA","code_information":[{"code":"2901206","type":"CDM"},{"code":"510","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ABLATE INF TURBINATE-MMA","code_information":[{"code":"2901209","type":"CDM"},{"code":"510","type":"RC"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CONTROL OF NOSEBLEED-MMA","code_information":[{"code":"2901212","type":"CDM"},{"code":"510","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPEAT CONTR OF NOSEBL-MMA","code_information":[{"code":"2901215","type":"CDM"},{"code":"510","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.25,"setting":"both","billing_class":"professional"}]},{"description":"NASAL ENDO  DX-MMA","code_information":[{"code":"2901218","type":"CDM"},{"code":"510","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"NSL/SINS NDSC DX MAX ENDO-MMA","code_information":[{"code":"2901221","type":"CDM"},{"code":"510","type":"RC"},{"code":"31233","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.25,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX SPHN ENDO-MMA","code_information":[{"code":"2901224","type":"CDM"},{"code":"510","type":"RC"},{"code":"31235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.75,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC BX POLYPC-MMA","code_information":[{"code":"2901227","type":"CDM"},{"code":"510","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1761.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DIAGNOSTIC LARYNGOSCOPY-MMA","code_information":[{"code":"2901233","type":"CDM"},{"code":"510","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CAPILLARY BLOOD DRAW-MMA","code_information":[{"code":"2901237","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.0,"setting":"both","billing_class":"facility"},{"gross_charge":4.0,"setting":"both","billing_class":"professional"}]},{"description":"INJ THERAPY OF VEINS-MMA","code_information":[{"code":"2901238","type":"CDM"},{"code":"510","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISION OF TONGUE FOLD-MMA","code_information":[{"code":"2901239","type":"CDM"},{"code":"510","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM TUNNELED CV CATH-MMA","code_information":[{"code":"2901241","type":"CDM"},{"code":"510","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM TUNNELED CV CATH-MMA","code_information":[{"code":"2901244","type":"CDM"},{"code":"510","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1354.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF LIP-MMA","code_information":[{"code":"2901500","type":"CDM"},{"code":"510","type":"RC"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISION OF LIP FOLD-MMA","code_information":[{"code":"2901503","type":"CDM"},{"code":"510","type":"RC"},{"code":"40806","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF MOUTH LESION-MMA","code_information":[{"code":"2901506","type":"CDM"},{"code":"510","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.75,"setting":"both","billing_class":"professional"}]},{"description":"EX OF MOUTH LESION-MMA","code_information":[{"code":"2901509","type":"CDM"},{"code":"510","type":"RC"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXISE/REPAIR MOUTH LESION-MMA","code_information":[{"code":"2901512","type":"CDM"},{"code":"510","type":"RC"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF TONGUE-MMA","code_information":[{"code":"2901518","type":"CDM"},{"code":"510","type":"RC"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX OF TONGUE LESION-MMA","code_information":[{"code":"2901521","type":"CDM"},{"code":"510","type":"RC"},{"code":"41110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2765.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX OF TONGUE FOLD-MMA","code_information":[{"code":"2901524","type":"CDM"},{"code":"510","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX LESION  MOUTH ROOF-MMA","code_information":[{"code":"2901527","type":"CDM"},{"code":"510","type":"RC"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":2774.0,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION  MOUTH ROOF-MMA","code_information":[{"code":"2901530","type":"CDM"},{"code":"510","type":"RC"},{"code":"42106","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF SALIVARY GLAND-MMA","code_information":[{"code":"2901533","type":"CDM"},{"code":"510","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF TONSIL ABSC-MMA","code_information":[{"code":"2901536","type":"CDM"},{"code":"510","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF THROAT-MMA","code_information":[{"code":"2901539","type":"CDM"},{"code":"510","type":"RC"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2658.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXISE PHARYNX LESION-MMA","code_information":[{"code":"2901542","type":"CDM"},{"code":"510","type":"RC"},{"code":"42808","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CHANGE GASTROSTOMY TUBE-MMA","code_information":[{"code":"2901545","type":"CDM"},{"code":"510","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.75,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSCOPY DX-MMA","code_information":[{"code":"2901548","type":"CDM"},{"code":"510","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISION OF RECTAL ABSC-MMA","code_information":[{"code":"2901551","type":"CDM"},{"code":"510","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISION OF ANAL ABSCESS-MMA","code_information":[{"code":"2901554","type":"CDM"},{"code":"510","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISE EXT HEMORRHOID-MMA","code_information":[{"code":"2901557","type":"CDM"},{"code":"510","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"LIGATION OF HEMORRHOID-MMA","code_information":[{"code":"2901560","type":"CDM"},{"code":"510","type":"RC"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF ANAL TAGS-MMA","code_information":[{"code":"2901563","type":"CDM"},{"code":"510","type":"RC"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2847.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF HEMORRHOID CLOT-MMA","code_information":[{"code":"2901566","type":"CDM"},{"code":"510","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DIAGNOSTIC ANOSCOPY-MMA","code_information":[{"code":"2901569","type":"CDM"},{"code":"510","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ANOSCOPY AND DILATION-MMA","code_information":[{"code":"2901572","type":"CDM"},{"code":"510","type":"RC"},{"code":"46604","type":"HCPCS"}],"standard_charges":[{"gross_charge":2026.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ANOSCOPY AND BX-MMA","code_information":[{"code":"2901575","type":"CDM"},{"code":"510","type":"RC"},{"code":"46606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT  ANAL LESION-MMA","code_information":[{"code":"2901578","type":"CDM"},{"code":"510","type":"RC"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EX OF ANAL LESION-MMA","code_information":[{"code":"2901581","type":"CDM"},{"code":"510","type":"RC"},{"code":"46922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TX FINGER FX EA-MMA","code_information":[{"code":"2901582","type":"CDM"},{"code":"510","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EA-MMA","code_information":[{"code":"2901583","type":"CDM"},{"code":"510","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1864.5,"setting":"both","billing_class":"professional"}]},{"description":"REPL DUOD/JEJ TUBE PERC-MMA","code_information":[{"code":"2901584","type":"CDM"},{"code":"510","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ULTRASOUND OB FOLLOW UP-MMA","code_information":[{"code":"2901587","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.5,"setting":"both","billing_class":"facility"},{"gross_charge":152.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"IRRIGATION OF BLADDER-MMA","code_information":[{"code":"2901800","type":"CDM"},{"code":"510","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INSERT BLADDER CATHETER-MMA","code_information":[{"code":"2901803","type":"CDM"},{"code":"510","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INSERT TEMP BLADDER CATH-MMA","code_information":[{"code":"2901806","type":"CDM"},{"code":"510","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CHANGE OF BLADDER TUBE-MMA","code_information":[{"code":"2901809","type":"CDM"},{"code":"510","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"UROCUFF TEST-MMA","code_information":[{"code":"2901813","type":"CDM"},{"code":"510","type":"RC"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"setting":"both","modifiers":"52","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"ELECTRO/UROFLOWMETRY 1ST-MMA","code_information":[{"code":"2901815","type":"CDM"},{"code":"510","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-MMA","code_information":[{"code":"2901818","type":"CDM"},{"code":"510","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.5,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-MMA","code_information":[{"code":"2901821","type":"CDM"},{"code":"510","type":"RC"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"setting":"both","billing_class":"professional"}]},{"description":"INTRAABD PRESS TST-MMA","code_information":[{"code":"2901824","type":"CDM"},{"code":"510","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":1149.75,"setting":"both","billing_class":"professional"}]},{"description":"US URINE CAPACITY MEASURE-MMA","code_information":[{"code":"2901827","type":"CDM"},{"code":"510","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY-MMA","code_information":[{"code":"2901830","type":"CDM"},{"code":"510","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CYSTOSCOPY W BX-MMA","code_information":[{"code":"2901833","type":"CDM"},{"code":"510","type":"RC"},{"code":"52204","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-MMA","code_information":[{"code":"2901836","type":"CDM"},{"code":"510","type":"RC"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-MMA","code_information":[{"code":"2901841","type":"CDM"},{"code":"510","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2238.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CYSTOSCOPY AND TREAT-MMA","code_information":[{"code":"2901844","type":"CDM"},{"code":"510","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DILATE URETHRA STRICTURE-MMA","code_information":[{"code":"2901847","type":"CDM"},{"code":"510","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.25,"setting":"both","billing_class":"professional"}]},{"description":"DILATION OF URETHRA-MMA","code_information":[{"code":"2901850","type":"CDM"},{"code":"510","type":"RC"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"setting":"both","billing_class":"professional"}]},{"description":"DILATION OF URETHRA-MMA","code_information":[{"code":"2901853","type":"CDM"},{"code":"510","type":"RC"},{"code":"53661","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT PENIS LESION-MMA","code_information":[{"code":"2901856","type":"CDM"},{"code":"510","type":"RC"},{"code":"54050","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTRUCT PENIS LESION-MMA","code_information":[{"code":"2901859","type":"CDM"},{"code":"510","type":"RC"},{"code":"54055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1919.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CRYOSURGERY PENIS LESION-MMA","code_information":[{"code":"2901862","type":"CDM"},{"code":"510","type":"RC"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"LYSIS PENIL CIRCUMIC LES-MMA","code_information":[{"code":"2901865","type":"CDM"},{"code":"510","type":"RC"},{"code":"54162","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT OF PENIS LESION-MMA","code_information":[{"code":"2901868","type":"CDM"},{"code":"510","type":"RC"},{"code":"54200","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.75,"setting":"both","billing_class":"professional"}]},{"description":"PREPUTIAL STRETCHING-MMA","code_information":[{"code":"2901871","type":"CDM"},{"code":"510","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF SCROTUM-MMA","code_information":[{"code":"2901874","type":"CDM"},{"code":"510","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2337.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF HYDROCELE-MMA","code_information":[{"code":"2901877","type":"CDM"},{"code":"510","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SCROTUM ABSC-MMA","code_information":[{"code":"2901880","type":"CDM"},{"code":"510","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1842.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM OF SPERM DUCT-MMA","code_information":[{"code":"2901883","type":"CDM"},{"code":"510","type":"RC"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2435.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF PROSTATE-MMA","code_information":[{"code":"2901886","type":"CDM"},{"code":"510","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2217.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"I & D OF VULVA/PERINEUM-MMA","code_information":[{"code":"2901889","type":"CDM"},{"code":"510","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAINAGE OF GLAND ABSCESS-MMA","code_information":[{"code":"2901892","type":"CDM"},{"code":"510","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY VULVA LESIONS SIM-MMA","code_information":[{"code":"2901895","type":"CDM"},{"code":"510","type":"RC"},{"code":"56501","type":"HCPCS"}],"standard_charges":[{"gross_charge":2078.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY VULVA LESION CMPLX-MMA","code_information":[{"code":"2901898","type":"CDM"},{"code":"510","type":"RC"},{"code":"56515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2171.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF VULVA/PERINEUM-MMA","code_information":[{"code":"2901901","type":"CDM"},{"code":"510","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF VULVA/PERINEUM-MMA","code_information":[{"code":"2901904","type":"CDM"},{"code":"510","type":"RC"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY VAG LESION-MMA","code_information":[{"code":"2901907","type":"CDM"},{"code":"510","type":"RC"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2806.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTROY VAG LESION-MMA","code_information":[{"code":"2901910","type":"CDM"},{"code":"510","type":"RC"},{"code":"57065","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF VAGINA-MMA","code_information":[{"code":"2901913","type":"CDM"},{"code":"510","type":"RC"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INSERT PESSARY/OTH DEVICE-MMA","code_information":[{"code":"2901916","type":"CDM"},{"code":"510","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXAM/BX OF VAG W/SCOPE-MMA","code_information":[{"code":"2901919","type":"CDM"},{"code":"510","type":"RC"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXAM OF CERVIX W/SCOPE-MMA","code_information":[{"code":"2901922","type":"CDM"},{"code":"510","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX/CURETT CERVIX W/SCOPE-MMA","code_information":[{"code":"2901925","type":"CDM"},{"code":"510","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF CERVIX W/SCOPE LEEP-MMA","code_information":[{"code":"2901928","type":"CDM"},{"code":"510","type":"RC"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3545.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"COLPOSCOPY CERV W/SC LEEP-MMA","code_information":[{"code":"2901929","type":"CDM"},{"code":"510","type":"RC"},{"code":"57461","type":"HCPCS"}],"standard_charges":[{"gross_charge":3584.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX-MMA","code_information":[{"code":"2901931","type":"CDM"},{"code":"510","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CONIZATION OF CERVIX-MMA","code_information":[{"code":"2901934","type":"CDM"},{"code":"510","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":3540.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF UTERUS LINING-MMA","code_information":[{"code":"2901937","type":"CDM"},{"code":"510","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INSERT INTRAUTERINE DEV-MMA","code_information":[{"code":"2901940","type":"CDM"},{"code":"510","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM INTRAUTERINE DEVICE-MMA","code_information":[{"code":"2901943","type":"CDM"},{"code":"510","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ANTEPARTUM CARE ONLY-MMA","code_information":[{"code":"2901946","type":"CDM"},{"code":"519","type":"RC"},{"code":"59425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ANTEPARTUM CARE ONLY-MMA","code_information":[{"code":"2901947","type":"CDM"},{"code":"519","type":"RC"},{"code":"59426","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CARE AFTER DELIVERY-MMA","code_information":[{"code":"2901948","type":"CDM"},{"code":"519","type":"RC"},{"code":"59430","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SPINAL FLUID TAP-MMA","code_information":[{"code":"2902200","type":"CDM"},{"code":"510","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"N BLOCK INJ  TRIGEMINAL-MMA","code_information":[{"code":"2902203","type":"CDM"},{"code":"510","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  OCCIP BIL-MMA","code_information":[{"code":"2902206","type":"CDM"},{"code":"510","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"N BLOCK INJ PUDENDAL-MMA","code_information":[{"code":"2902209","type":"CDM"},{"code":"510","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK OTHER PERIPHERAL-MMA","code_information":[{"code":"2902212","type":"CDM"},{"code":"510","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"N BLOCK INJ PLANTAR DIGIT-MMA","code_information":[{"code":"2902215","type":"CDM"},{"code":"510","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTR W NEUROLYTIC AGENT-MMA","code_information":[{"code":"2902217","type":"CDM"},{"code":"510","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN SALIV GLANDS-MMA","code_information":[{"code":"2902218","type":"CDM"},{"code":"510","type":"RC"},{"code":"64611","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE  FACE MUSC-MMA","code_information":[{"code":"2902221","type":"CDM"},{"code":"510","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CHEMODEN MUSC MIGRAINE-MMA","code_information":[{"code":"2902224","type":"CDM"},{"code":"510","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK DYSTON-MMA","code_information":[{"code":"2902227","type":"CDM"},{"code":"510","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTR 1-4 MUSCS-MMA","code_information":[{"code":"2902230","type":"CDM"},{"code":"510","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTR 1-4 ADDL-MMA","code_information":[{"code":"2902233","type":"CDM"},{"code":"510","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTREM 5/> MUS-MMA","code_information":[{"code":"2902236","type":"CDM"},{"code":"510","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EX 5/> EA ADDL-MMA","code_information":[{"code":"2902239","type":"CDM"},{"code":"510","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"professional"}]},{"description":"EX NEUROMA CUTANEOUS-MMA","code_information":[{"code":"2902242","type":"CDM"},{"code":"510","type":"RC"},{"code":"64774","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FROM EYE-MMA","code_information":[{"code":"2902245","type":"CDM"},{"code":"510","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BLEPHAROTOMY DRAIN ABSC-MMA","code_information":[{"code":"2902248","type":"CDM"},{"code":"510","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN EXTERNAL EAR LESION-MMA","code_information":[{"code":"2902251","type":"CDM"},{"code":"510","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":863.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DRAIN EXTERNAL EAR LESION-MMA","code_information":[{"code":"2902254","type":"CDM"},{"code":"510","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF EXTERNAL EAR-MMA","code_information":[{"code":"2902257","type":"CDM"},{"code":"510","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX OF EXTERNAL EAR CANAL-MMA","code_information":[{"code":"2902260","type":"CDM"},{"code":"510","type":"RC"},{"code":"69105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.25,"setting":"both","billing_class":"professional"}]},{"description":"CLEAR OUTER EAR CANAL-MMA","code_information":[{"code":"2902263","type":"CDM"},{"code":"510","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM IMPCT EARWAX W/TOOL-MMA","code_information":[{"code":"2902269","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.25,"setting":"both","billing_class":"professional"}]},{"description":"CLEAN OUT MASTOID CAVITY-MMA","code_information":[{"code":"2902272","type":"CDM"},{"code":"510","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISION OF EARDRUM-MMA","code_information":[{"code":"2902275","type":"CDM"},{"code":"510","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CREATE EARDRUM OPENING-MMA","code_information":[{"code":"2902278","type":"CDM"},{"code":"510","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INCISE INNER EAR-MMA","code_information":[{"code":"2902281","type":"CDM"},{"code":"510","type":"RC"},{"code":"69801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE 1 OR 2 VIEW LT-MMA","code_information":[{"code":"2902401","type":"CDM"},{"code":"510","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 3 VIEW LT-MMA","code_information":[{"code":"2902402","type":"CDM"},{"code":"510","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 4 VIEW LT-MMA","code_information":[{"code":"2902403","type":"CDM"},{"code":"510","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"REM IMPACTED EARWAX BIL-MMA","code_information":[{"code":"2902404","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM EYELID LESIONS BIL-MMA","code_information":[{"code":"2902405","type":"CDM"},{"code":"510","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2002.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSE TEAR DUCTS OPEN BIL-MMA","code_information":[{"code":"2902406","type":"CDM"},{"code":"510","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BX OF CERVIX W/SCOPE-MMA","code_information":[{"code":"2902407","type":"CDM"},{"code":"510","type":"RC"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPEN BIL-MMA","code_information":[{"code":"2902408","type":"CDM"},{"code":"510","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"ULTRASOUND GUIDE INTRAOP-MMA","code_information":[{"code":"2902409","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"URINALYSIS AUTO W/O SCOPE-MMA","code_information":[{"code":"2902410","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED PX LUNGS & PLEURA-MMA","code_information":[{"code":"2902411","type":"CDM"},{"code":"510","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 30MINS-MMA","code_information":[{"code":"2902412","type":"CDM"},{"code":"914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 45MINS-MMA","code_information":[{"code":"2902413","type":"CDM"},{"code":"914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 60MINS-MMA","code_information":[{"code":"2902414","type":"CDM"},{"code":"914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UP LID BIL-MMA","code_information":[{"code":"2902415","type":"CDM"},{"code":"510","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":3810.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REMOVAL OF IMPLANT DEEP-MMA","code_information":[{"code":"2902416","type":"CDM"},{"code":"510","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":3568.75,"setting":"both","billing_class":"professional"}]},{"description":"PLETHYSMOGRAPHY (PFT)-MMA","code_information":[{"code":"2902417","type":"CDM"},{"code":"510","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"setting":"both","billing_class":"professional"}]},{"description":"DIFFUSING CAPACITY-MMA","code_information":[{"code":"2902418","type":"CDM"},{"code":"510","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"professional"}]},{"description":"ABD PARACENTESIS W/IMAGE-MMA","code_information":[{"code":"2902419","type":"CDM"},{"code":"510","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW HIGH 60 MIN-MMA","code_information":[{"code":"2902420","type":"CDM"},{"code":"960","type":"RC"},{"code":"98011","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST SF 10 MIN-MMA","code_information":[{"code":"2902421","type":"CDM"},{"code":"960","type":"RC"},{"code":"98012","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST LOW 20 MIN-MMA","code_information":[{"code":"2902422","type":"CDM"},{"code":"960","type":"RC"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST MOD 30 MIN-MMA","code_information":[{"code":"2902423","type":"CDM"},{"code":"960","type":"RC"},{"code":"98014","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST HIGH 40 MIN-MMA","code_information":[{"code":"2902424","type":"CDM"},{"code":"960","type":"RC"},{"code":"98015","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"setting":"both","billing_class":"professional"}]},{"description":"ESCHAROTOMY 1ST INCISION-MMA","code_information":[{"code":"2902425","type":"CDM"},{"code":"510","type":"RC"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF RIBS-MMA","code_information":[{"code":"2902500","type":"CDM"},{"code":"510","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF BREASTBONE-MMA","code_information":[{"code":"2902503","type":"CDM"},{"code":"510","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-MMA","code_information":[{"code":"2902506","type":"CDM"},{"code":"510","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-MMA","code_information":[{"code":"2902509","type":"CDM"},{"code":"510","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-MMA","code_information":[{"code":"2902512","type":"CDM"},{"code":"510","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF THORACIC SPINE-MMA","code_information":[{"code":"2902515","type":"CDM"},{"code":"510","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF TRUNK SPINE-MMA","code_information":[{"code":"2902518","type":"CDM"},{"code":"510","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPI 2/3 VW-MMA","code_information":[{"code":"2902521","type":"CDM"},{"code":"510","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-MMA","code_information":[{"code":"2902524","type":"CDM"},{"code":"510","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-MMA","code_information":[{"code":"2902527","type":"CDM"},{"code":"510","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF PELVIS-MMA","code_information":[{"code":"2902530","type":"CDM"},{"code":"510","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF TAILBONE-MMA","code_information":[{"code":"2902533","type":"CDM"},{"code":"510","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY COLLAR BONE-MMA","code_information":[{"code":"2902536","type":"CDM"},{"code":"510","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF SHOULDER BLADE-MMA","code_information":[{"code":"2902539","type":"CDM"},{"code":"510","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF SHOULDER-MMA","code_information":[{"code":"2902542","type":"CDM"},{"code":"510","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER 2 VIEW RT-MMA","code_information":[{"code":"2902545","type":"CDM"},{"code":"510","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY OF SHOULDERS-MMA","code_information":[{"code":"2902548","type":"CDM"},{"code":"510","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER CMPLT BIL-MMA","code_information":[{"code":"2902549","type":"CDM"},{"code":"510","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY HUMERUS-MMA","code_information":[{"code":"2902551","type":"CDM"},{"code":"510","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ELBOW-MMA","code_information":[{"code":"2902554","type":"CDM"},{"code":"510","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ELBOW 3 VIEW RT-MMA","code_information":[{"code":"2902557","type":"CDM"},{"code":"510","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FOREARM-MMA","code_information":[{"code":"2902560","type":"CDM"},{"code":"510","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST-MMA","code_information":[{"code":"2902563","type":"CDM"},{"code":"510","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST 3 VIEW RT-MMA","code_information":[{"code":"2902566","type":"CDM"},{"code":"510","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HAND-MMA","code_information":[{"code":"2902569","type":"CDM"},{"code":"510","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HAND 3 VIEW RT-MMA","code_information":[{"code":"2902572","type":"CDM"},{"code":"510","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FINGER-MMA","code_information":[{"code":"2902575","type":"CDM"},{"code":"510","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP UNI 1 VIEW-MMA","code_information":[{"code":"2902578","type":"CDM"},{"code":"510","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP 2-3 VIEW RT-MMA","code_information":[{"code":"2902581","type":"CDM"},{"code":"510","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HIP UNI 4/> VIEWS-MMA","code_information":[{"code":"2902584","type":"CDM"},{"code":"510","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 2 VIEWS-MMA","code_information":[{"code":"2902587","type":"CDM"},{"code":"510","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 3-4 VIEWS-MMA","code_information":[{"code":"2902590","type":"CDM"},{"code":"510","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 5/> VIEWS-MMA","code_information":[{"code":"2902593","type":"CDM"},{"code":"510","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF FEMUR 1-MMA","code_information":[{"code":"2902596","type":"CDM"},{"code":"510","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF FEMUR 2/>-MMA","code_information":[{"code":"2902599","type":"CDM"},{"code":"510","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE 1 OR 2 VIEW RT-MMA","code_information":[{"code":"2902602","type":"CDM"},{"code":"510","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 3 VIEW RT-MMA","code_information":[{"code":"2902605","type":"CDM"},{"code":"510","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 4 VIEW RT-MMA","code_information":[{"code":"2902608","type":"CDM"},{"code":"510","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEES BIL STANDING-MMA","code_information":[{"code":"2902611","type":"CDM"},{"code":"510","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER LEG-MMA","code_information":[{"code":"2902614","type":"CDM"},{"code":"510","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF LEG  INFANT-MMA","code_information":[{"code":"2902617","type":"CDM"},{"code":"510","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ANKLE-MMA","code_information":[{"code":"2902620","type":"CDM"},{"code":"510","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ANKLE-MMA","code_information":[{"code":"2902623","type":"CDM"},{"code":"510","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE BILATERAL-MMA","code_information":[{"code":"2902624","type":"CDM"},{"code":"510","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE BILATERAL-MMA","code_information":[{"code":"2902625","type":"CDM"},{"code":"510","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY FOOT-MMA","code_information":[{"code":"2902626","type":"CDM"},{"code":"510","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FOOT-MMA","code_information":[{"code":"2902629","type":"CDM"},{"code":"510","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HEEL-MMA","code_information":[{"code":"2902632","type":"CDM"},{"code":"510","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY TOE-MMA","code_information":[{"code":"2902635","type":"CDM"},{"code":"510","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND HEAD AND NECK-MMA","code_information":[{"code":"2902638","type":"CDM"},{"code":"510","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND TRANSRECTAL-MMA","code_information":[{"code":"2902641","type":"CDM"},{"code":"510","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"setting":"both","billing_class":"professional"}]},{"description":"ECHO GUIDE FOR BX-MMA","code_information":[{"code":"2902644","type":"CDM"},{"code":"510","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND RETROPERITONEAL-MMA","code_information":[{"code":"2902647","type":"CDM"},{"code":"510","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MNL APPL STRESS JNT-MMA","code_information":[{"code":"2902648","type":"CDM"},{"code":"510","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.75,"setting":"both","billing_class":"professional"}]},{"description":"URINALYSIS NONAUTO W/SCOPE-MMA","code_information":[{"code":"2902900","type":"CDM"},{"code":"300","type":"RC"},{"code":"81000","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.25,"setting":"both","billing_class":"facility"},{"gross_charge":6.25,"setting":"both","billing_class":"professional"}]},{"description":"METABOLIC PANEL IONIZED-MMA","code_information":[{"code":"2902901","type":"CDM"},{"code":"300","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"facility"},{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"URINALYSIS NONAUTO-MMA","code_information":[{"code":"2902902","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"setting":"both","billing_class":"facility"},{"gross_charge":6.0,"setting":"both","billing_class":"professional"}]},{"description":"URINE PREGNANCY TST-MMA","code_information":[{"code":"2902904","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"facility"},{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"MICROALBUMIN  SEMIQUANT-MMA","code_information":[{"code":"2902906","type":"CDM"},{"code":"300","type":"RC"},{"code":"82044","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.25,"setting":"both","billing_class":"facility"},{"gross_charge":7.25,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD  OTH SOURCE-MMA","code_information":[{"code":"2902908","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"BLOOD OCCULT PEROXIDASE-MMA","code_information":[{"code":"2902910","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"REAGENT STRIP/BL GLUCOSE-MMA","code_information":[{"code":"2902912","type":"CDM"},{"code":"300","type":"RC"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.25,"setting":"both","billing_class":"facility"},{"gross_charge":6.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE BLOOD TST-MMA","code_information":[{"code":"2902914","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"GLYCOSYLATED HEMOGLOBIN-MMA","code_information":[{"code":"2902916","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":20.5,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"ASSAY OF LEAD-MMA","code_information":[{"code":"2902918","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"facility"},{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"HEMOGLOBIN-MMA","code_information":[{"code":"2902921","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":5.25,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"PROTHROMBIN TIME-MMA","code_information":[{"code":"2902923","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.25,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":7.25,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HETEROPHILE ANTIBODIES-MMA","code_information":[{"code":"2902925","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"TB INTRADERMAL TST-MMA","code_information":[{"code":"2902927","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"facility"},{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"SMEAR  WET MOUNT-MMA","code_information":[{"code":"2902929","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.25,"setting":"both","billing_class":"facility"},{"gross_charge":8.25,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA DNA AMP PROBE-MMA","code_information":[{"code":"2902935","type":"CDM"},{"code":"300","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":118.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"RSV DNA/RNA AMP PROBE-MMA","code_information":[{"code":"2902937","type":"CDM"},{"code":"300","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":98.0,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"STREP A DNA AMP PROBE-MMA","code_information":[{"code":"2902939","type":"CDM"},{"code":"300","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":49.0,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"LIPID PANEL-MMA","code_information":[{"code":"2902947","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"facility"},{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"IMM ADM ANY ROUTE 1ST-MMA","code_information":[{"code":"2903202","type":"CDM"},{"code":"771","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"IMM ADM ADDL VAC-MMA","code_information":[{"code":"2903204","type":"CDM"},{"code":"771","type":"RC"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"facility"},{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNIZATION ADMIN-MMA","code_information":[{"code":"2903207","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNE ADMIN EA ADD-MMA","code_information":[{"code":"2903210","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.5,"setting":"both","billing_class":"facility"},{"gross_charge":29.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNE ADMIN ORAL/NASAL-MMA","code_information":[{"code":"2903212","type":"CDM"},{"code":"771","type":"RC"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNE ADMIN OR/NAS ADDL-MMA","code_information":[{"code":"2903214","type":"CDM"},{"code":"771","type":"RC"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"facility"},{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"MENINGOCOCCAL B 4C VACC-MMA","code_information":[{"code":"2903216","type":"CDM"},{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.75,"setting":"both","billing_class":"facility"},{"gross_charge":212.75,"setting":"both","billing_class":"professional"}]},{"description":"MENINGOCOCCAL VACCINE IM-MMA","code_information":[{"code":"2903219","type":"CDM"},{"code":"636","type":"RC"},{"code":"90621","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.75,"setting":"both","billing_class":"facility"},{"gross_charge":177.75,"setting":"both","billing_class":"professional"}]},{"description":"HEP A VAC PED/ADOL 2 DOSE-MMA","code_information":[{"code":"2903225","type":"CDM"},{"code":"636","type":"RC"},{"code":"90633","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"facility"},{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"HEP A VAC PED/ADOL 3 DOSE-MMA","code_information":[{"code":"2903228","type":"CDM"},{"code":"636","type":"RC"},{"code":"90634","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","billing_class":"facility"},{"gross_charge":32.75,"setting":"both","billing_class":"professional"}]},{"description":"HEP A/HEP B VAC ADULT IM-MMA","code_information":[{"code":"2903231","type":"CDM"},{"code":"636","type":"RC"},{"code":"90636","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"setting":"both","billing_class":"facility"},{"gross_charge":114.0,"setting":"both","billing_class":"professional"}]},{"description":"HIB VACCINE  PRP-OMP  IM-MMA","code_information":[{"code":"2903233","type":"CDM"},{"code":"636","type":"RC"},{"code":"90647","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"HIB VACCINE  PRP-T  IM-MMA","code_information":[{"code":"2903236","type":"CDM"},{"code":"636","type":"RC"},{"code":"90648","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"H PAPILLOMA VAC 3 DOSE-MMA","code_information":[{"code":"2903239","type":"CDM"},{"code":"510","type":"RC"},{"code":"90649","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"facility"},{"gross_charge":184.75,"setting":"both","billing_class":"professional"}]},{"description":"HPV VACCINE NON VALENT IM-MMA","code_information":[{"code":"2903242","type":"CDM"},{"code":"636","type":"RC"},{"code":"90651","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC NO PRESERV 6-35M-MMA","code_information":[{"code":"2903245","type":"CDM"},{"code":"636","type":"RC"},{"code":"90655","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU IIV3 VAC NO PRSV 0.5ML-MMA","code_information":[{"code":"2903248","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU VACCINE  6-35 MO  IM-MMA","code_information":[{"code":"2903250","type":"CDM"},{"code":"636","type":"RC"},{"code":"90657","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC AGE 3 & OVER  IM-MMA","code_information":[{"code":"2903253","type":"CDM"},{"code":"636","type":"RC"},{"code":"90658","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU LAIV3 VAC NASAL MIST-MMA","code_information":[{"code":"2903255","type":"CDM"},{"code":"510","type":"RC"},{"code":"90660","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","billing_class":"facility"},{"gross_charge":32.75,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC PRSV FREE-MMA","code_information":[{"code":"2903256","type":"CDM"},{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"setting":"both","billing_class":"facility"},{"gross_charge":87.0,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC 4VAL NASAL-MMA","code_information":[{"code":"2903262","type":"CDM"},{"code":"636","type":"RC"},{"code":"90672","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"FLU VACC RIV3 NO PRESERV-MMA","code_information":[{"code":"2903265","type":"CDM"},{"code":"636","type":"RC"},{"code":"90673","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"},{"gross_charge":86.75,"setting":"both","billing_class":"professional"}]},{"description":"CCIIV4 VAC NO PRSV 0.5ML-MMA","code_information":[{"code":"2903266","type":"CDM"},{"code":"636","type":"RC"},{"code":"90674","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"facility"},{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"ROTOVIRUS VAC 3 DOSE ORAL-MMA","code_information":[{"code":"2903269","type":"CDM"},{"code":"636","type":"RC"},{"code":"90680","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"ROTAVIRUS VAC 2 DOSE-MMA","code_information":[{"code":"2903272","type":"CDM"},{"code":"636","type":"RC"},{"code":"90681","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"facility"},{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"RIV4 VAC RECOMBINANT DNA-MMA","code_information":[{"code":"2903275","type":"CDM"},{"code":"636","type":"RC"},{"code":"90682","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC NO PRS 4VAL 6-35-MMA","code_information":[{"code":"2903277","type":"CDM"},{"code":"636","type":"RC"},{"code":"90685","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC 4VAL 6-35MO-MMA","code_information":[{"code":"2903283","type":"CDM"},{"code":"636","type":"RC"},{"code":"90687","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC 4VAL 3 YRS+MMA","code_information":[{"code":"2903286","type":"CDM"},{"code":"636","type":"RC"},{"code":"90688","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"setting":"both","billing_class":"facility"},{"gross_charge":26.0,"setting":"both","billing_class":"professional"}]},{"description":"TYPHOID VACCINE  IM-MMA","code_information":[{"code":"2903289","type":"CDM"},{"code":"636","type":"RC"},{"code":"90691","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"DTAP-IPV 4-6 YEARS-MMA","code_information":[{"code":"2903291","type":"CDM"},{"code":"636","type":"RC"},{"code":"90696","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.5,"setting":"both","billing_class":"facility"},{"gross_charge":61.5,"setting":"both","billing_class":"professional"}]},{"description":"DTAP-HIB-IP VACCINE  IM-MMA","code_information":[{"code":"2903294","type":"CDM"},{"code":"636","type":"RC"},{"code":"90698","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"DTAP VACCINE  < 7 YRS  IM-MMA","code_information":[{"code":"2903297","type":"CDM"},{"code":"636","type":"RC"},{"code":"90700","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"facility"},{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"MMRV VACCINE  SC-MMA","code_information":[{"code":"2903304","type":"CDM"},{"code":"636","type":"RC"},{"code":"90710","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","billing_class":"facility"},{"gross_charge":348.0,"setting":"both","billing_class":"professional"}]},{"description":"POLIOVIRUS  IPV  SC/IM-MMA","code_information":[{"code":"2903307","type":"CDM"},{"code":"636","type":"RC"},{"code":"90713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.25,"setting":"both","billing_class":"facility"},{"gross_charge":41.25,"setting":"both","billing_class":"professional"}]},{"description":"CHICKEN POX VACCINE  SC-MMA","code_information":[{"code":"2903316","type":"CDM"},{"code":"636","type":"RC"},{"code":"90716","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"setting":"both","billing_class":"facility"},{"gross_charge":160.0,"setting":"both","billing_class":"professional"}]},{"description":"DTAP-HEP B-IPV VAC-MMA","code_information":[{"code":"2903319","type":"CDM"},{"code":"636","type":"RC"},{"code":"90723","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.75,"setting":"both","billing_class":"facility"},{"gross_charge":94.75,"setting":"both","billing_class":"professional"}]},{"description":"MENINGOCOCCAL ACWY VAC SC-MMA","code_information":[{"code":"2903325","type":"CDM"},{"code":"636","type":"RC"},{"code":"90733","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.25,"setting":"both","billing_class":"facility"},{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"MENINGOCOCCAL ACWY VACC IM-MMA","code_information":[{"code":"2903328","type":"CDM"},{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"facility"},{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"ZOSTER VACC  SC-MMA","code_information":[{"code":"2903331","type":"CDM"},{"code":"636","type":"RC"},{"code":"90736","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"setting":"both","billing_class":"facility"},{"gross_charge":244.0,"setting":"both","billing_class":"professional"}]},{"description":"HEPB VAC PED/ADOL 3 DOSE-MMA","code_information":[{"code":"2903333","type":"CDM"},{"code":"636","type":"RC"},{"code":"90744","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"setting":"both","billing_class":"facility"},{"gross_charge":28.0,"setting":"both","billing_class":"professional"}]},{"description":"HEP B VACCINE ADULT IM-MMA","code_information":[{"code":"2903336","type":"CDM"},{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"},{"gross_charge":74.0,"setting":"both","billing_class":"professional"}]},{"description":"HEP B/HIB VACCINE  IM-MMA","code_information":[{"code":"2903338","type":"CDM"},{"code":"636","type":"RC"},{"code":"90748","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"HZV VAC RECOMBINANT-MMA","code_information":[{"code":"2903341","type":"CDM"},{"code":"636","type":"RC"},{"code":"90750","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.5,"setting":"both","billing_class":"facility"},{"gross_charge":184.5,"setting":"both","billing_class":"professional"}]},{"description":"BREATH HYDROGEN TST-MMA","code_information":[{"code":"2903343","type":"CDM"},{"code":"510","type":"RC"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG ANT-MMA","code_information":[{"code":"2903346","type":"CDM"},{"code":"510","type":"RC"},{"code":"92132","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH IMG OPTIC NRV-MMA","code_information":[{"code":"2903349","type":"CDM"},{"code":"510","type":"RC"},{"code":"92133","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG POST-MMA","code_information":[{"code":"2903352","type":"CDM"},{"code":"510","type":"RC"},{"code":"92134","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"professional"}]},{"description":"EAR MICROSCOPY EXAM-MMA","code_information":[{"code":"2903355","type":"CDM"},{"code":"510","type":"RC"},{"code":"92504","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.25,"setting":"both","billing_class":"professional"}]},{"description":"CALORIC VSTBLR TST W/REC-MMA","code_information":[{"code":"2903358","type":"CDM"},{"code":"510","type":"RC"},{"code":"92537","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.75,"setting":"both","billing_class":"professional"}]},{"description":"CALORIC VSTBLR TST W/REC-MMA","code_information":[{"code":"2903361","type":"CDM"},{"code":"510","type":"RC"},{"code":"92538","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.5,"setting":"both","billing_class":"professional"}]},{"description":"BASIC VESTIBULAR EVAL-MMA","code_information":[{"code":"2903364","type":"CDM"},{"code":"510","type":"RC"},{"code":"92540","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"SPONTANEOUS NYSTAGMUS TST-MMA","code_information":[{"code":"2903367","type":"CDM"},{"code":"510","type":"RC"},{"code":"92541","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.5,"setting":"both","billing_class":"professional"}]},{"description":"COMPREHENSIVE HEARING TST-MMA","code_information":[{"code":"2903370","type":"CDM"},{"code":"510","type":"RC"},{"code":"92557","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.75,"setting":"both","billing_class":"professional"}]},{"description":"TYMPANOMETRY-MMA","code_information":[{"code":"2903373","type":"CDM"},{"code":"510","type":"RC"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"setting":"both","billing_class":"professional"}]},{"description":"ECG MONITOR/REC 48 HRS-MMA","code_information":[{"code":"2903381","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"facility"},{"gross_charge":133.75,"setting":"both","billing_class":"professional"}]},{"description":"ECG RECORDING-MMA","code_information":[{"code":"2903384","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTICOAG MGMT PT WARFARIN-MMA","code_information":[{"code":"2903387","type":"CDM"},{"code":"519","type":"RC"},{"code":"93793","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"BREATHING CAPACITY TST-MMA","code_information":[{"code":"2903388","type":"CDM"},{"code":"510","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EVALUATION OF WHEEZING-MMA","code_information":[{"code":"2903391","type":"CDM"},{"code":"510","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"setting":"both","billing_class":"professional"}]},{"description":"PULMONARY STRESS TSTING-MMA","code_information":[{"code":"2903394","type":"CDM"},{"code":"510","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.5,"setting":"both","billing_class":"professional"}]},{"description":"AIRWAY INHALATION TREAT-MMA","code_information":[{"code":"2903397","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"facility"},{"gross_charge":212.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EVAL PT USE OF INHALER-MMA","code_information":[{"code":"2903399","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"setting":"both","billing_class":"facility"},{"gross_charge":213.0,"setting":"both","billing_class":"professional"}]},{"description":"MEASURE BL OXYGEN LEVEL-MMA","code_information":[{"code":"2903402","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"facility"},{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"MEASURE BL OXYGEN LEVEL-MMA","code_information":[{"code":"2903404","type":"CDM"},{"code":"460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"setting":"both","billing_class":"facility"},{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"PERCUT ALLERGY SKIN TSTS-MMA","code_information":[{"code":"2903406","type":"CDM"},{"code":"519","type":"RC"},{"code":"95004","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"PERQ&IC ALLG TST DRUGS-MMA","code_information":[{"code":"2903407","type":"CDM"},{"code":"519","type":"RC"},{"code":"95018","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"ID ALLERGY TST  DRUG/BUG-MMA","code_information":[{"code":"2903408","type":"CDM"},{"code":"519","type":"RC"},{"code":"95024","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"INGEST CHALLENGE 120MIN-MMA","code_information":[{"code":"2903409","type":"CDM"},{"code":"519","type":"RC"},{"code":"95076","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOTHERAPY  ONE INJ-MMA","code_information":[{"code":"2903410","type":"CDM"},{"code":"940","type":"RC"},{"code":"95115","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOTHERAPY INJECTIONS-MMA","code_information":[{"code":"2903412","type":"CDM"},{"code":"940","type":"RC"},{"code":"95117","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"facility"},{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"CONT GLUC MNTR EQP-MMA","code_information":[{"code":"2903415","type":"CDM"},{"code":"920","type":"RC"},{"code":"95249","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE MONITORING  CONT-MMA","code_information":[{"code":"2903417","type":"CDM"},{"code":"920","type":"RC"},{"code":"95250","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.75,"setting":"both","billing_class":"facility"},{"gross_charge":128.75,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE MONITORING CONT-MMA","code_information":[{"code":"2903420","type":"CDM"},{"code":"519","type":"RC"},{"code":"95251","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST 1 LIMB-MMA","code_information":[{"code":"2903421","type":"CDM"},{"code":"510","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.5,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRAN NRV UNIL-MMA","code_information":[{"code":"2903424","type":"CDM"},{"code":"510","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.75,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG THORACIC-MMA","code_information":[{"code":"2903427","type":"CDM"},{"code":"510","type":"RC"},{"code":"95869","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST  NONPARASPINAL-MMA","code_information":[{"code":"2903430","type":"CDM"},{"code":"510","type":"RC"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.25,"setting":"both","billing_class":"professional"}]},{"description":"GUIDE NERV DESTR NDL EMG-MMA","code_information":[{"code":"2903433","type":"CDM"},{"code":"510","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/NERV TST LIM-MMA","code_information":[{"code":"2903436","type":"CDM"},{"code":"510","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/N TST COMP-MMA","code_information":[{"code":"2903439","type":"CDM"},{"code":"510","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/N TST NONEXT-MMA","code_information":[{"code":"2903442","type":"CDM"},{"code":"510","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 1-2 NRV CNDJ-MMA","code_information":[{"code":"2903445","type":"CDM"},{"code":"510","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 3-4 NRV CNDJ-MMA","code_information":[{"code":"2903448","type":"CDM"},{"code":"510","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 5-6 NRV CNDJ-MMA","code_information":[{"code":"2903451","type":"CDM"},{"code":"510","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.5,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 7-8 NRV CNDJ-MMA","code_information":[{"code":"2903454","type":"CDM"},{"code":"510","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.5,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SEN 9-10 NRV CNDJ-MMA","code_information":[{"code":"2903457","type":"CDM"},{"code":"510","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SEN 11-12 NRV CND-MMA","code_information":[{"code":"2903460","type":"CDM"},{"code":"510","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 13/> NRV CND-MMA","code_information":[{"code":"2903463","type":"CDM"},{"code":"510","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"professional"}]},{"description":"CANALITH REPOSITIONING-MMA","code_information":[{"code":"2903469","type":"CDM"},{"code":"510","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROBEHAVIORAL EXAM-MMA","code_information":[{"code":"2903472","type":"CDM"},{"code":"519","type":"RC"},{"code":"96116","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"setting":"both","billing_class":"professional"}]},{"description":"THER/PROPH/DIAG INJ-MMA","code_information":[{"code":"2903475","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO HORM ANTINEOPL-MMA","code_information":[{"code":"2903478","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE/20 CM OR <-MMA","code_information":[{"code":"2903481","type":"CDM"},{"code":"510","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ACTIVE WOUND CARE > 20 CM-MMA","code_information":[{"code":"2903484","type":"CDM"},{"code":"510","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"NEG PRESS WOUND TX <50CM-MMA","code_information":[{"code":"2903487","type":"CDM"},{"code":"510","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"NEG PRESS WOUND TX >50CM-MMA","code_information":[{"code":"2903490","type":"CDM"},{"code":"510","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OSTEOPATHIC MAN 1-2 REGNS-MMA","code_information":[{"code":"2903493","type":"CDM"},{"code":"510","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OSTEOPATHIC MAN 3-4 REGNS-MMA","code_information":[{"code":"2903496","type":"CDM"},{"code":"510","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"MEDICAL SERV AFT HRS-MMA","code_information":[{"code":"2903501","type":"CDM"},{"code":"519","type":"RC"},{"code":"99050","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"SPECIAL REPORTS OR FORMS-MMA","code_information":[{"code":"2903504","type":"CDM"},{"code":"519","type":"RC"},{"code":"99080","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"VISUAL ACUITY SCREEN-MMA","code_information":[{"code":"2903506","type":"CDM"},{"code":"519","type":"RC"},{"code":"99173","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"setting":"both","billing_class":"professional"}]},{"description":"APP TOPICAL FLUORIDE-MMA","code_information":[{"code":"2903507","type":"CDM"},{"code":"519","type":"RC"},{"code":"99188","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 2 NEW-MMA","code_information":[{"code":"2903509","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 3 NEW -MMA","code_information":[{"code":"2903510","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 4 NEW -MMA","code_information":[{"code":"2903511","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 5 NEW -MMA","code_information":[{"code":"2903514","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 1 EST-MMA","code_information":[{"code":"2903515","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 2 EST-MMA","code_information":[{"code":"2903516","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 3 EST-MMA","code_information":[{"code":"2903517","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 4 EST-MMA","code_information":[{"code":"2903518","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE VISIT LEV 5 EST-MMA","code_information":[{"code":"2903519","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OFFICE CONSULT STRT FWD-MMA","code_information":[{"code":"2903521","type":"CDM"},{"code":"510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT MOD LEVEL-MMA","code_information":[{"code":"2903522","type":"CDM"},{"code":"510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT HIGH LEVEL-MMA","code_information":[{"code":"2903523","type":"CDM"},{"code":"510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  INFANT -MMA","code_information":[{"code":"2903524","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  AGE 1-4 -MMA","code_information":[{"code":"2903525","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 5-11 -MMA","code_information":[{"code":"2903526","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 12-17 -MMA","code_information":[{"code":"2903527","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 18-39 -MMA","code_information":[{"code":"2903528","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 40-64 -MMA","code_information":[{"code":"2903529","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW 65 & OVER -MMA","code_information":[{"code":"2903530","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  INFANT -MMA","code_information":[{"code":"2903531","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  AGE 1-4 -MMA","code_information":[{"code":"2903532","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 5-11 -MMA","code_information":[{"code":"2903533","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 12-17 -MMA","code_information":[{"code":"2903534","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 18-39 -MMA","code_information":[{"code":"2903535","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 40-64 -MMA","code_information":[{"code":"2903536","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST 65 & OVER-MMA","code_information":[{"code":"2903537","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","billing_class":"professional"}]},{"description":"SMOKE/TOB COUNSEL 3-10M-MMA","code_information":[{"code":"2903539","type":"CDM"},{"code":"519","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"professional"}]},{"description":"SMOKING/TOB COUNSEL >10M-MMA","code_information":[{"code":"2903540","type":"CDM"},{"code":"519","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"WORK EVALUATION-MMA","code_information":[{"code":"2903542","type":"CDM"},{"code":"519","type":"RC"},{"code":"99455","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"setting":"both","billing_class":"professional"}]},{"description":"WORK EVALUATION-MMA","code_information":[{"code":"2903543","type":"CDM"},{"code":"519","type":"RC"},{"code":"99456","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"setting":"both","billing_class":"professional"}]},{"description":"CHRON CARE MGMT SRVC 20M-MMA","code_information":[{"code":"2903544","type":"CDM"},{"code":"519","type":"RC"},{"code":"99490","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"CHRON CARE MGMT SRVC 30M-MMA","code_information":[{"code":"2903546","type":"CDM"},{"code":"519","type":"RC"},{"code":"99491","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT LOW LEVEL-MMA","code_information":[{"code":"2903549","type":"CDM"},{"code":"510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"setting":"both","billing_class":"professional"}]},{"description":"BEYFORTUS (Health Department)","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2903605","type":"CDM"},{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281057500","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"setting":"both","billing_class":"facility"}]},{"description":"BEYFORTUS (Health Department)","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2903606","type":"CDM"},{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281057488","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"setting":"both","billing_class":"facility"}]},{"description":"PESSARY, NON-RUBBER A4562-MMA","code_information":[{"code":"2903852","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4562","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"facility"},{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"PESSARY, RUBBER A4561-MMA","code_information":[{"code":"2903853","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4561","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.25,"setting":"both","billing_class":"facility"},{"gross_charge":83.25,"setting":"both","billing_class":"professional"}]},{"description":"COLLAGEN WOUND FILLER-MMA","code_information":[{"code":"2903854","type":"CDM"},{"code":"519","type":"RC"},{"code":"A6010","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"COLLAGEN DRSG <=16 SQ IN-MMA","code_information":[{"code":"2903855","type":"CDM"},{"code":"519","type":"RC"},{"code":"A6021","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG IODOFLEX/IODOSORB-MMA","code_information":[{"code":"2903856","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6222","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"ZINC BAND W>=3IN<5IN/YD-MMA","code_information":[{"code":"2903857","type":"CDM"},{"code":"519","type":"RC"},{"code":"A6456","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"SUPPLY/ACCESSORY/SERVICE-MMA","code_information":[{"code":"2903858","type":"CDM"},{"code":"519","type":"RC"},{"code":"A9900","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"professional"}]},{"description":"AQUABAND-MMA","code_information":[{"code":"2903859","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"SK GR LOW COST ADD 25CM-MMA","code_information":[{"code":"2903862","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.75,"setting":"both","billing_class":"facility"},{"gross_charge":182.75,"setting":"both","billing_class":"professional"}]},{"description":"SK GR LOW COST 1ST 25C-MMA","code_information":[{"code":"2903863","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.75,"setting":"both","billing_class":"facility"},{"gross_charge":546.75,"setting":"both","billing_class":"professional"}]},{"description":"SK GR LOW COST ADD 25C-MMA","code_information":[{"code":"2903864","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.75,"setting":"both","billing_class":"facility"},{"gross_charge":182.75,"setting":"both","billing_class":"professional"}]},{"description":"EARMOLD-MMA","code_information":[{"code":"2903865","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN INFLUENZA VIRUS VAC-MMA","code_information":[{"code":"2903868","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN PNEUM VAC-MMA","code_information":[{"code":"2903870","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN HEPATITIS B VACCINE-MMA","code_information":[{"code":"2903872","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"facility"},{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"CA SCR PELVIC/BREAST EXAM-MMA","code_information":[{"code":"2903874","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"PROSTATE CA SCR; DRE-MMA","code_information":[{"code":"2903875","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0102","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"MD RECERTIFICATION HH PT-MMA","code_information":[{"code":"2903876","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0179","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"MD CERTIFICATION HH PT-MMA","code_information":[{"code":"2903877","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0180","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL PREVENTATIVE EXAM-MMA","code_information":[{"code":"2903881","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.75,"setting":"both","billing_class":"professional"}]},{"description":"ANNUAL WELLNESS INITIAL-MMA","code_information":[{"code":"2903888","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"ANNUAL WELLNESS  SUBSQ-MMA","code_information":[{"code":"2903891","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"DEPRESSION SCREEN ANNUAL-MMA","code_information":[{"code":"2903894","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID RET SERV FEE-MMA","code_information":[{"code":"2903972","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID EXTRA WAR-MMA","code_information":[{"code":"2903973","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"ABOBOTULINUMTOXINA 500UNIT-MMA","code_information":[{"code":"2903978","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0586","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.25,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"ABOBOTULINUMTOXIN 300UNIT-MMA","code_information":[{"code":"2903979","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0586","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.5,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"BOTULINUM TOXIN TYPE B-MMA","code_information":[{"code":"2903980","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0587","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":15.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"PROCHLORPERAZINE INJ-MMA","code_information":[{"code":"2903986","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":5.25,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"DEPO ESTRADIOL CYPION INJ-MMA","code_information":[{"code":"2903990","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1000","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"facility"},{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"METHYLPREDNIS 20 MG INJ-MMA","code_information":[{"code":"2903992","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.25,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":6.25,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"HYMOVIS INJECTION 1 MG-MMA","code_information":[{"code":"2904046","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7322","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"ORTHOVISC INJ PER DOSE-MMA","code_information":[{"code":"2904050","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7324","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"facility"},{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"GEL-ONE-MMA","code_information":[{"code":"2904054","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7326","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.5,"setting":"both","billing_class":"facility"},{"gross_charge":1402.5,"setting":"both","billing_class":"professional"}]},{"description":"MONOVISC INJ PER DOSE-MMA","code_information":[{"code":"2904056","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.25,"setting":"both","billing_class":"facility"},{"gross_charge":1022.25,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC 4VAL 3 YRS+MMA","code_information":[{"code":"2904063","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2036","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"FLU VAC AGE 3+MMA","code_information":[{"code":"2904065","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2038","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"},{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LONG ARM ADULT FBRG-MMA","code_information":[{"code":"2904067","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LONG ARM ADULT FBRG-MMA","code_information":[{"code":"2904067","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4006","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LONG ARM PED FBRGLS-MMA","code_information":[{"code":"2904068","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LONG ARM PED FBRGLS-MMA","code_information":[{"code":"2904068","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4008","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHT ARM ADULT FBRGL-MMA","code_information":[{"code":"2904069","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHT ARM ADULT FBRGL-MMA","code_information":[{"code":"2904069","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4010","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHT ARM PED FBRGLAS-MMA","code_information":[{"code":"2904070","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHT ARM PED FBRGLAS-MMA","code_information":[{"code":"2904070","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4012","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"CAST GAUNTLET FIBERGLASS-MMA","code_information":[{"code":"2904071","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"facility"}]},{"description":"CAST GAUNTLET FIBERGLASS-MMA","code_information":[{"code":"2904071","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4014","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"CAST GAUNTLET PED FBRGLS-MMA","code_information":[{"code":"2904072","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"}]},{"description":"CAST GAUNTLET PED FBRGLS-MMA","code_information":[{"code":"2904072","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4016","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LNG ARM SPLINT PLST-MMA","code_information":[{"code":"2904073","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LNG ARM SPLINT PLST-MMA","code_information":[{"code":"2904073","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4017","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LNG ARM SPLINT FBRG-MMA","code_information":[{"code":"2904074","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LNG ARM SPLINT FBRG-MMA","code_information":[{"code":"2904074","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4018","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LNG ARM SPLNT PED F-MMA","code_information":[{"code":"2904075","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LNG ARM SPLNT PED F-MMA","code_information":[{"code":"2904075","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4020","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST SHT ARM SPLINT PLST-MMA","code_information":[{"code":"2904076","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST SHT ARM SPLINT PLST-MMA","code_information":[{"code":"2904076","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4021","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST SHT ARM SPLINT FBRG-MMA","code_information":[{"code":"2904077","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"facility"}]},{"description":"CAST SHT ARM SPLINT FBRG-MMA","code_information":[{"code":"2904077","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4022","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"CAST SHT ARM SPLNT PED F-MMA","code_information":[{"code":"2904078","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST SHT ARM SPLNT PED F-MMA","code_information":[{"code":"2904078","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4024","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LONG LEG FIBERGLASS-MMA","code_information":[{"code":"2904079","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LONG LEG FIBERGLASS-MMA","code_information":[{"code":"2904079","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4030","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"CAST LNG LEG PED PLASTER-MMA","code_information":[{"code":"2904080","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST LNG LEG PED PLASTER-MMA","code_information":[{"code":"2904080","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4031","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LNG LEG PED FBRGLS-MMA","code_information":[{"code":"2904081","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":116.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LNG LEG PED FBRGLS-MMA","code_information":[{"code":"2904081","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4032","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  LNGLEG CYLNDR PED F-MMA","code_information":[{"code":"2904082","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  LNGLEG CYLNDR PED F-MMA","code_information":[{"code":"2904082","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4036","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHRT LEG FIBERGLASS-MMA","code_information":[{"code":"2904083","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHRT LEG FIBERGLASS-MMA","code_information":[{"code":"2904083","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4038","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHRT LEG PED PLSTER-MMA","code_information":[{"code":"2904084","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHRT LEG PED PLSTER-MMA","code_information":[{"code":"2904084","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4039","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHRT LEG PED FBRGLS-MMA","code_information":[{"code":"2904085","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHRT LEG PED FBRGLS-MMA","code_information":[{"code":"2904085","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHT LEG SPLNT PLSTR-MMA","code_information":[{"code":"2904086","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHT LEG SPLNT PLSTR-MMA","code_information":[{"code":"2904086","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4045","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHT LEG SPLNT FBRGL-MMA","code_information":[{"code":"2904087","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHT LEG SPLNT FBRGL-MMA","code_information":[{"code":"2904087","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4046","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"CAST  SHT LEG SPLNT PED F-MMA","code_information":[{"code":"2904088","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"facility"}]},{"description":"CAST  SHT LEG SPLNT PED F-MMA","code_information":[{"code":"2904088","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4048","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"CAST SUPPLIES UNLISTED-MMA","code_information":[{"code":"2904089","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"facility"}]},{"description":"CAST SUPPLIES UNLISTED-MMA","code_information":[{"code":"2904089","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4050","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 14MM DISC-MMA","code_information":[{"code":"2904090","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.25,"setting":"both","billing_class":"facility"},{"gross_charge":570.25,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 18MM-MMA","code_information":[{"code":"2904091","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.5,"setting":"both","billing_class":"facility"},{"gross_charge":1139.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 2X3CM-MMA","code_information":[{"code":"2904092","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.5,"setting":"both","billing_class":"facility"},{"gross_charge":1708.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 2X4CM-MMA","code_information":[{"code":"2904093","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":2277.75,"setting":"both","billing_class":"facility"},{"gross_charge":2277.75,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 3.5X3.5CM-MMA","code_information":[{"code":"2904094","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.5,"setting":"both","billing_class":"facility"},{"gross_charge":3487.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 4X4CM-MMA","code_information":[{"code":"2904095","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":4554.5,"setting":"both","billing_class":"facility"},{"gross_charge":4554.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX 4X4.5CM-MMA","code_information":[{"code":"2904096","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":5123.5,"setting":"both","billing_class":"facility"},{"gross_charge":5123.5,"setting":"both","billing_class":"professional"}]},{"description":"WC EPIFIX/EPICORD 1SQ CM-MMA","code_information":[{"code":"2904097","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.75,"setting":"both","billing_class":"facility"},{"gross_charge":284.75,"setting":"both","billing_class":"professional"}]},{"description":"MED CONFERENCE BY PHYSIC-MMA","code_information":[{"code":"2904099","type":"CDM"},{"code":"519","type":"RC"},{"code":"S0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SUTURES-MMA","code_information":[{"code":"2904100","type":"CDM"},{"code":"519","type":"RC"},{"code":"S0630","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID REPAIR/MODIF-MMA","code_information":[{"code":"2904104","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5014","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DISPENSING FEE-MMA","code_information":[{"code":"2904105","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5241","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904106","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5254","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904107","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904108","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5256","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904109","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5257","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904110","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5258","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904111","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5259","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904112","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2904113","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"EAR MOLD/INSERT-MMA","code_information":[{"code":"2904114","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5264","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.75,"setting":"both","billing_class":"professional"}]},{"description":"BATTERY FOR HEARING DEV-MMA","code_information":[{"code":"2904115","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5266","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.25,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID SUPPLY/ACC-MMA","code_information":[{"code":"2904116","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5267","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"HEARING SERVICE-MMA","code_information":[{"code":"2904118","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5299","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED DRUG-MMA","code_information":[{"code":"2904120","type":"CDM"},{"code":"350","type":"RC"}],"standard_charges":[{"gross_charge":0.05,"setting":"both","billing_class":"professional"}]},{"description":"WC BANDAGE ACE N/S 4 IN-MMA","code_information":[{"code":"2904152","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6449","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"facility"},{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"WC BANDAGE ACE N/S 6 IN-MMA","code_information":[{"code":"2904153","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6450","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"WC BANDAGE COBAN ELASTIC-MMA","code_information":[{"code":"2904154","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6454","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"facility"},{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG 4 X 4 STER-MMA","code_information":[{"code":"2904155","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6402","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG ABD STER 8 X 7.5-MMA","code_information":[{"code":"2904156","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6253","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG ACTACOAT 7-MMA","code_information":[{"code":"2904157","type":"CDM"},{"code":"270","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG ADAPTIC STER-MMA","code_information":[{"code":"2904158","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6222","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG 4X4X12 PLY STER-MMA","code_information":[{"code":"2904159","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6402","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.25,"setting":"both","billing_class":"facility"},{"gross_charge":2.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG AQUACEL AG HYD-MMA","code_information":[{"code":"2904160","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"},{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG AQUACEL ROPE HYDRA-MMA","code_information":[{"code":"2904161","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6199","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG COMPRES PROFORE-MMA","code_information":[{"code":"2904162","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6452","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG DERMABOND TPCL-MMA","code_information":[{"code":"2904163","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6452","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"facility"},{"gross_charge":145.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG DUODERM CGF 4X4-MMA","code_information":[{"code":"2904164","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6235","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"},{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG DUODERM THIN 4X4-MMA","code_information":[{"code":"2904165","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6235","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG IODOFORM GZE 5%-MMA","code_information":[{"code":"2904168","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6266","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":49.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG KERLIX ROLL-MMA","code_information":[{"code":"2904169","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6443","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG MEPILEX 10X10CM-MMA","code_information":[{"code":"2904171","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"facility"},{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG MEPILEX BORDER 3X3-MMA","code_information":[{"code":"2904172","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6213","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"facility"},{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG PRISMA MATRIX-MMA","code_information":[{"code":"2904173","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6021","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"facility"},{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG MEPILEX AG 4X4-MMA","code_information":[{"code":"2904174","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG SILVERCEL 4 X 4-MMA","code_information":[{"code":"2904175","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG MEPITEL SILICONE-MMA","code_information":[{"code":"2904176","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6207","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"WC UNNAFLEX PLUS-MMA","code_information":[{"code":"2904177","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6456","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG IODOFORM 5% 1/4 IN-MMA","code_information":[{"code":"2904178","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6266","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG AQUACEL FOAM 8X8-MMA","code_information":[{"code":"2904180","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"facility"},{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG AQUACEL FOAM 10X10-MMA","code_information":[{"code":"2904181","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.25,"setting":"both","billing_class":"facility"},{"gross_charge":20.25,"setting":"both","billing_class":"professional"}]},{"description":"WC DRSG AQUACEL FOAM 15X20-MMA","code_information":[{"code":"2904182","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"},{"gross_charge":36.0,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 16MM DISC-MMA","code_information":[{"code":"2904186","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.5,"setting":"both","billing_class":"facility"},{"gross_charge":1242.5,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 1.5X2CM-MMA","code_information":[{"code":"2904187","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2203.75,"setting":"both","billing_class":"facility"},{"gross_charge":2203.75,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 2X3CM-MMA","code_information":[{"code":"2904188","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.25,"setting":"both","billing_class":"facility"},{"gross_charge":2509.25,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 3X3CM-MMA","code_information":[{"code":"2904189","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2845.0,"setting":"both","billing_class":"facility"},{"gross_charge":2845.0,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 3X4CM-MMA","code_information":[{"code":"2904190","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.25,"setting":"both","billing_class":"facility"},{"gross_charge":3072.25,"setting":"both","billing_class":"professional"}]},{"description":"WC GRAFIX 5X5CM-MMA","code_information":[{"code":"2904191","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":6034.5,"setting":"both","billing_class":"facility"},{"gross_charge":6034.5,"setting":"both","billing_class":"professional"}]},{"description":"FINGER SPLINT, STATIC-MMA","code_information":[{"code":"2904192","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4049","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.5,"setting":"both","billing_class":"facility"},{"gross_charge":2.5,"setting":"both","billing_class":"professional"}]},{"description":"EPIFIX 2X2CM GRAFT-MMA","code_information":[{"code":"2904193","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":2810.25,"setting":"both","billing_class":"facility"},{"gross_charge":2810.25,"setting":"both","billing_class":"professional"}]},{"description":"WC AQUACEL DRSG 2X2-MMA","code_information":[{"code":"2904194","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6196","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.25,"setting":"both","billing_class":"facility"},{"gross_charge":15.25,"setting":"both","billing_class":"professional"}]},{"description":"WC CONVAMAX DRSG 10X20CM-MMA","code_information":[{"code":"2904195","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.0,"setting":"both","billing_class":"facility"},{"gross_charge":7.0,"setting":"both","billing_class":"professional"}]},{"description":"WC CONVAMAX DRSG 15X20CM-MMA","code_information":[{"code":"2904196","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"WC CONVAMAX DRSG 20X30CM-MMA","code_information":[{"code":"2904197","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6198","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","billing_class":"facility"},{"gross_charge":20.0,"setting":"both","billing_class":"professional"}]},{"description":"WC HYDROFERA FOAM DRSG 2X2-MMA","code_information":[{"code":"2904198","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6209","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"setting":"both","billing_class":"facility"},{"gross_charge":18.0,"setting":"both","billing_class":"professional"}]},{"description":"WC HYDROFERA FOAM DRSG 4X5-MMA","code_information":[{"code":"2904199","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6210","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"setting":"both","billing_class":"facility"},{"gross_charge":18.0,"setting":"both","billing_class":"professional"}]},{"description":"WC KERECIS 16MM DISC-MMA","code_information":[{"code":"2904200","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"setting":"both","billing_class":"facility"},{"gross_charge":611.0,"setting":"both","billing_class":"professional"}]},{"description":"WC KERECIS 1.75X1.75CM-MMA","code_information":[{"code":"2904201","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.75,"setting":"both","billing_class":"facility"},{"gross_charge":807.75,"setting":"both","billing_class":"professional"}]},{"description":"WC KERECIS 3X3.5CM-MMA","code_information":[{"code":"2904202","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.5,"setting":"both","billing_class":"facility"},{"gross_charge":1384.5,"setting":"both","billing_class":"professional"}]},{"description":"WC KERECIS 8CM SQUARED-MMA","code_information":[{"code":"2904203","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.75,"setting":"both","billing_class":"facility"},{"gross_charge":1097.75,"setting":"both","billing_class":"professional"}]},{"description":"WC HYDROFERA FOAM DRSG 6X6-MMA","code_information":[{"code":"2904204","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6210","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"WC MEPILEX AG FOAM DSG 6X6-MMA","code_information":[{"code":"2904205","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6210","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"facility"},{"gross_charge":34.5,"setting":"both","billing_class":"professional"}]},{"description":"WC DUODERM HYDROGEL TUBE-MMA","code_information":[{"code":"2904206","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6248","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.75,"setting":"both","billing_class":"facility"},{"gross_charge":6.75,"setting":"both","billing_class":"professional"}]},{"description":"WC IODOSORB IODINE GEL-MMA","code_information":[{"code":"2904207","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6261","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"setting":"both","billing_class":"facility"},{"gross_charge":30.0,"setting":"both","billing_class":"professional"}]},{"description":"WC THERAHONEYGEL .5OZ TUBE-MMA","code_information":[{"code":"2904208","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4649","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"setting":"both","billing_class":"facility"},{"gross_charge":10.0,"setting":"both","billing_class":"professional"}]},{"description":"CAST SHT ARM SPLNT PED PLS-MMA","code_information":[{"code":"2904209","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4023","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"facility"},{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"SOMATULINE 1MG(60MG INJ)-MMA","code_information":[{"code":"2904300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"}],"standard_charges":[{"gross_charge":7762.5,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":7762.5,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"PSYTX W PT 45MIN-MMA","code_information":[{"code":"2905010","type":"CDM"},{"code":"519","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.5,"setting":"both","billing_class":"professional"}]},{"description":"FAM PSY TX 45MIN-MMA","code_information":[{"code":"2905011","type":"CDM"},{"code":"519","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"GROUP PSY TX-MMA","code_information":[{"code":"2905012","type":"CDM"},{"code":"519","type":"RC"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYTX W PT 60MIN-MMA","code_information":[{"code":"2905013","type":"CDM"},{"code":"519","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"TPRNL BIODEGRADE MATRL-MMA","code_information":[{"code":"2905014","type":"CDM"},{"code":"510","type":"RC"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5233.75,"setting":"both","billing_class":"professional"}]},{"description":"PLACE DEVICE/MARKER-MMA","code_information":[{"code":"2905015","type":"CDM"},{"code":"510","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SKIN/MSCL FX-MMA","code_information":[{"code":"2905016","type":"CDM"},{"code":"510","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHAVE LES F/E/N/L >2CM-MMA","code_information":[{"code":"2905017","type":"CDM"},{"code":"510","type":"RC"},{"code":"11313","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"FNA W/O IMAGE ADDL-MMA","code_information":[{"code":"2905018","type":"CDM"},{"code":"510","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.75,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN-MMA","code_information":[{"code":"2905019","type":"CDM"},{"code":"510","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.75,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN ADDL-MMA","code_information":[{"code":"2905020","type":"CDM"},{"code":"510","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-MMA","code_information":[{"code":"2905021","type":"CDM"},{"code":"510","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PUNCH BX SKIN SINGLE LES-MMA","code_information":[{"code":"2905069","type":"CDM"},{"code":"510","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.25,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN SINGLE LES-MMA","code_information":[{"code":"2905069","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN EA SEP/ADDL-MMA","code_information":[{"code":"2905070","type":"CDM"},{"code":"510","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN EA SEP/ADDL-MMA","code_information":[{"code":"2905070","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"}]},{"description":"INCAL BX SKN EA SEP/ADDL-MMA","code_information":[{"code":"2905072","type":"CDM"},{"code":"510","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN EA SEP/ADDL-MMA","code_information":[{"code":"2905072","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":76.0,"setting":"both","billing_class":"facility"}]},{"description":"DEB MSC/FASCIA ADDL =<20CM-MMA","code_information":[{"code":"2905073","type":"CDM"},{"code":"510","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DEB MSC/FASCIA ADDL =<20CM-MMA","code_information":[{"code":"2905073","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":130.0,"setting":"both","billing_class":"facility"}]},{"description":"EXC F/E/N/L MAL 0.5CM<-MMA","code_information":[{"code":"2905074","type":"CDM"},{"code":"510","type":"RC"},{"code":"11640","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC F/E/N/L MAL 0.5CM<-MMA","code_information":[{"code":"2905074","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":765.0,"setting":"both","billing_class":"facility"}]},{"description":"I&D FOREARM/WRIST-MMA","code_information":[{"code":"2905077","type":"CDM"},{"code":"510","type":"RC"},{"code":"25031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.75,"setting":"both","billing_class":"professional"}]},{"description":"I&D FOREARM/WRIST-MMA","code_information":[{"code":"2905077","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1801.0,"setting":"both","billing_class":"facility"}]},{"description":"CL TX MALLET FINGER-MMA","code_information":[{"code":"2905078","type":"CDM"},{"code":"510","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":2029.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CL TX MALLET FINGER-MMA","code_information":[{"code":"2905078","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1946.0,"setting":"both","billing_class":"facility"}]},{"description":"CL TX TARSAL DISLOCATION-MMA","code_information":[{"code":"2905079","type":"CDM"},{"code":"510","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.5,"setting":"both","billing_class":"professional"}]},{"description":"CL TX TARSAL DISLOCATION-MMA","code_information":[{"code":"2905079","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":434.0,"setting":"both","billing_class":"facility"}]},{"description":"CONTROL NASAL HEMORR-MMA","code_information":[{"code":"2905080","type":"CDM"},{"code":"510","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CONTROL NASAL HEMORR-MMA","code_information":[{"code":"2905080","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":203.0,"setting":"both","billing_class":"facility"}]},{"description":"REMOVE FB EYE-MMA","code_information":[{"code":"2905081","type":"CDM"},{"code":"510","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REMOVE FB EYE-MMA","code_information":[{"code":"2905081","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":423.0,"setting":"both","billing_class":"facility"}]},{"description":"REMOVE FB EYE-MMA","code_information":[{"code":"2905082","type":"CDM"},{"code":"510","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REMOVE FB EYE-MMA","code_information":[{"code":"2905082","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"setting":"both","billing_class":"facility"}]},{"description":"TYMPAN/REFLEX THRESH-MMA","code_information":[{"code":"2905083","type":"CDM"},{"code":"519","type":"RC"},{"code":"92550","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"TYMPAN/REFLEX THRESH-MMA","code_information":[{"code":"2905083","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"facility"}]},{"description":"PURE TONE HEARING TST-MMA","code_information":[{"code":"2905084","type":"CDM"},{"code":"519","type":"RC"},{"code":"92551","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"setting":"both","billing_class":"professional"}]},{"description":"PURE TONE HEARING TST-MMA","code_information":[{"code":"2905084","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","billing_class":"facility"}]},{"description":"PURE TONE AUDIOM-MMA","code_information":[{"code":"2905085","type":"CDM"},{"code":"519","type":"RC"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"PURE TONE AUDIOM-MMA","code_information":[{"code":"2905085","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":52.0,"setting":"both","billing_class":"facility"}]},{"description":"AUDIOMETRY-MMA","code_information":[{"code":"2905086","type":"CDM"},{"code":"519","type":"RC"},{"code":"92553","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIOMETRY-MMA","code_information":[{"code":"2905086","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":61.0,"setting":"both","billing_class":"facility"}]},{"description":"SPEECH THRESHOLD AUD-MMA","code_information":[{"code":"2905087","type":"CDM"},{"code":"519","type":"RC"},{"code":"92555","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"SPEECH THRESHOLD AUD-MMA","code_information":[{"code":"2905087","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"setting":"both","billing_class":"facility"}]},{"description":"EVOKED AUDITORY TST-MMA","code_information":[{"code":"2905089","type":"CDM"},{"code":"519","type":"RC"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.75,"setting":"both","billing_class":"professional"}]},{"description":"EVOKED AUDITORY TST-MMA","code_information":[{"code":"2905089","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"EVOKED AUDITORY TST-MMA","code_information":[{"code":"2905090","type":"CDM"},{"code":"519","type":"RC"},{"code":"92588","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"EVOKED AUDITORY TST-MMA","code_information":[{"code":"2905090","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":54.0,"setting":"both","billing_class":"facility"}]},{"description":"DEVELOPM TST-MMA","code_information":[{"code":"2905092","type":"CDM"},{"code":"519","type":"RC"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"DEVELOPM TST-MMA","code_information":[{"code":"2905092","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","billing_class":"facility"}]},{"description":"BR EMOTIONAL/BEH ASSM-MMA","code_information":[{"code":"2905093","type":"CDM"},{"code":"519","type":"RC"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"BR EMOTIONAL/BEH ASSM-MMA","code_information":[{"code":"2905093","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":10.0,"setting":"both","billing_class":"facility"}]},{"description":"PAT FOCUS HEALTH RISK ASSM-MMA","code_information":[{"code":"2905094","type":"CDM"},{"code":"519","type":"RC"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"PAT FOCUS HEALTH RISK ASSM-MMA","code_information":[{"code":"2905094","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"facility"}]},{"description":"SHAVE LES S/N/H/F/G >2CM-MMA","code_information":[{"code":"2905095","type":"CDM"},{"code":"510","type":"RC"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC F/E/E/N/L >4CM-MMA","code_information":[{"code":"2905096","type":"CDM"},{"code":"510","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":3067.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC LES S/N/EX G >4CM-MMA","code_information":[{"code":"2905097","type":"CDM"},{"code":"510","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":3012.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ INTO SKIN LES >7-MMA","code_information":[{"code":"2905098","type":"CDM"},{"code":"510","type":"RC"},{"code":"11901","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REP SUP WND S/N/A/T/E-MMA","code_information":[{"code":"2905099","type":"CDM"},{"code":"510","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REP SUP WND F/E/N/L-MMA","code_information":[{"code":"2905100","type":"CDM"},{"code":"510","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REP SUP WND F/E/N/L-MMA","code_information":[{"code":"2905101","type":"CDM"},{"code":"510","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TX WND DEHIS-MMA","code_information":[{"code":"2905102","type":"CDM"},{"code":"510","type":"RC"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.25,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-MMA","code_information":[{"code":"2905103","type":"CDM"},{"code":"510","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-MMA","code_information":[{"code":"2905104","type":"CDM"},{"code":"510","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.75,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/T/E-MMA","code_information":[{"code":"2905105","type":"CDM"},{"code":"510","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2130.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND N/H/F/E-MMA","code_information":[{"code":"2905106","type":"CDM"},{"code":"510","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REP INT WND N/H/F/E-MMA","code_information":[{"code":"2905107","type":"CDM"},{"code":"510","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WND RPR F/E/N/L/MM 5.1-7.5-MMA","code_information":[{"code":"2905108","type":"CDM"},{"code":"510","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WND RPR N/H/F/G 12.6-20-MMA","code_information":[{"code":"2905109","type":"CDM"},{"code":"510","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WND RPR N/H/F/G 20.1-30-MMA","code_information":[{"code":"2905110","type":"CDM"},{"code":"510","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 30+MMA","code_information":[{"code":"2905111","type":"CDM"},{"code":"510","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 5.1-7.5-MMA","code_information":[{"code":"2905112","type":"CDM"},{"code":"510","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WND RPR F/MM 7.6-12.5-MMA","code_information":[{"code":"2905113","type":"CDM"},{"code":"510","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"WND RPR F/MM 12.6-20-MMA","code_information":[{"code":"2905114","type":"CDM"},{"code":"510","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.25,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 20.1-30-MMA","code_information":[{"code":"2905115","type":"CDM"},{"code":"510","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 30+MMA","code_information":[{"code":"2905116","type":"CDM"},{"code":"510","type":"RC"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES 10-50CM-MMA","code_information":[{"code":"2905118","type":"CDM"},{"code":"510","type":"RC"},{"code":"17107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES >50CM-MMA","code_information":[{"code":"2905119","type":"CDM"},{"code":"510","type":"RC"},{"code":"17108","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L .5CM/< -MMA","code_information":[{"code":"2905120","type":"CDM"},{"code":"510","type":"RC"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTR LES T/A/L .6-1CM -MMA","code_information":[{"code":"2905121","type":"CDM"},{"code":"510","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTR LES T/A/L 2.1-3CM-MMA","code_information":[{"code":"2905122","type":"CDM"},{"code":"510","type":"RC"},{"code":"17263","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTR LES T/A/L 3.1-4CM-MMA","code_information":[{"code":"2905123","type":"CDM"},{"code":"510","type":"RC"},{"code":"17264","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DESTR LES T/A/L >5CM-MMA","code_information":[{"code":"2905124","type":"CDM"},{"code":"510","type":"RC"},{"code":"17266","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PUNCT ASP BRST ADDL-MMA","code_information":[{"code":"2905125","type":"CDM"},{"code":"510","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR TUM DEEP >5CM-MMA","code_information":[{"code":"2905126","type":"CDM"},{"code":"510","type":"RC"},{"code":"23073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3488.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR LES <3CM-MMA","code_information":[{"code":"2905127","type":"CDM"},{"code":"510","type":"RC"},{"code":"23075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC SHLDR TUM DEEP <5CM-MMA","code_information":[{"code":"2905128","type":"CDM"},{"code":"510","type":"RC"},{"code":"23076","type":"HCPCS"}],"standard_charges":[{"gross_charge":3312.25,"setting":"both","billing_class":"professional"}]},{"description":"LAVAGE BY CANNULA-MMA","code_information":[{"code":"2905129","type":"CDM"},{"code":"510","type":"RC"},{"code":"31000","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW ASPIR-MMA","code_information":[{"code":"2905130","type":"CDM"},{"code":"510","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1641.0,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW BX-MMA","code_information":[{"code":"2905131","type":"CDM"},{"code":"510","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1642.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DX BONE MARROW BX&ASPIR-MMA","code_information":[{"code":"2905132","type":"CDM"},{"code":"510","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3353.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY ANAL LES-MMA","code_information":[{"code":"2905133","type":"CDM"},{"code":"510","type":"RC"},{"code":"46924","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CYSTOSCOPY AND TX-MMA","code_information":[{"code":"2905134","type":"CDM"},{"code":"510","type":"RC"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":3607.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-MMA","code_information":[{"code":"2905136","type":"CDM"},{"code":"510","type":"RC"},{"code":"52260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2217.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY CHEMODENERV-MMA","code_information":[{"code":"2905137","type":"CDM"},{"code":"510","type":"RC"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PROSTATIC THERMOTHERAPY-MMA","code_information":[{"code":"2905138","type":"CDM"},{"code":"510","type":"RC"},{"code":"53850","type":"HCPCS"}],"standard_charges":[{"gross_charge":3720.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-MMA","code_information":[{"code":"2905139","type":"CDM"},{"code":"510","type":"RC"},{"code":"54065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"INJ CORPORA CAVERNOSA-MMA","code_information":[{"code":"2905140","type":"CDM"},{"code":"510","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.75,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY OF VULVA-MMA","code_information":[{"code":"2905141","type":"CDM"},{"code":"510","type":"RC"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BX VAGINAL MUCOSA-MMA","code_information":[{"code":"2905142","type":"CDM"},{"code":"510","type":"RC"},{"code":"57105","type":"HCPCS"}],"standard_charges":[{"gross_charge":2828.5,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINAL FB-MMA","code_information":[{"code":"2905143","type":"CDM"},{"code":"510","type":"RC"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2866.25,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF VAGINA W/SCOPE-MMA","code_information":[{"code":"2905144","type":"CDM"},{"code":"510","type":"RC"},{"code":"57420","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM VENTIL TUBE/ANESTH-MMA","code_information":[{"code":"2905145","type":"CDM"},{"code":"510","type":"RC"},{"code":"69424","type":"HCPCS"}],"standard_charges":[{"gross_charge":2602.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CALCIUM IONOZED-MMA","code_information":[{"code":"2905146","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"facility"},{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE-MMA","code_information":[{"code":"2905147","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":5.25,"setting":"both","billing_class":"professional"}]},{"description":"KOH FOR FUNGI-MMA","code_information":[{"code":"2905148","type":"CDM"},{"code":"300","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.25,"setting":"both","billing_class":"facility"},{"gross_charge":6.25,"setting":"both","billing_class":"professional"}]},{"description":"CP CERV/VAG MANUAL SCR-MMA","code_information":[{"code":"2905149","type":"CDM"},{"code":"300","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"EKG 12 LEAD GLOBAL-MMA","code_information":[{"code":"2905152","type":"CDM"},{"code":"510","type":"RC"},{"code":"93000","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MASTOIDS >3-MMA","code_information":[{"code":"2905156","type":"CDM"},{"code":"510","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES <3-MMA","code_information":[{"code":"2905157","type":"CDM"},{"code":"510","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES >3-MMA","code_information":[{"code":"2905158","type":"CDM"},{"code":"510","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OPTIC FORAMINA-MMA","code_information":[{"code":"2905159","type":"CDM"},{"code":"510","type":"RC"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY NECK SOFT TISS-MMA","code_information":[{"code":"2905160","type":"CDM"},{"code":"510","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY CHEST 1 VIEW-MMA","code_information":[{"code":"2905161","type":"CDM"},{"code":"510","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"XRAY CHEST 2 VIEWS-MMA","code_information":[{"code":"2905162","type":"CDM"},{"code":"510","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"XRAY RIBS/CHEST >3 UNIL-MMA","code_information":[{"code":"2905163","type":"CDM"},{"code":"510","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS/CHEST >4 BILAT-MMA","code_information":[{"code":"2905164","type":"CDM"},{"code":"510","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 1 VIEW-MMA","code_information":[{"code":"2905166","type":"CDM"},{"code":"510","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 2 VIEWS-MMA","code_information":[{"code":"2905167","type":"CDM"},{"code":"510","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABD COMPL ACUTE-MMA","code_information":[{"code":"2905168","type":"CDM"},{"code":"510","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ SM JNT/BUR W/US-MMA","code_information":[{"code":"2905173","type":"CDM"},{"code":"510","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ INT JNT/BUR W/US-MMA","code_information":[{"code":"2905174","type":"CDM"},{"code":"510","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ <2CM-MMA","code_information":[{"code":"2905175","type":"CDM"},{"code":"510","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"XRAY RIBS 3 VIEWS BILAT-MMA","code_information":[{"code":"2905176","type":"CDM"},{"code":"510","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES < 3CM-MMA","code_information":[{"code":"2905177","type":"CDM"},{"code":"510","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CONTROL OF NOSE BLEED-MMA","code_information":[{"code":"2905178","type":"CDM"},{"code":"510","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TANGNTL BX SKIN SINGL LES-MMA","code_information":[{"code":"2905179","type":"CDM"},{"code":"510","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"TANGNTL BX SKIN ADDL LES-MMA","code_information":[{"code":"2905180","type":"CDM"},{"code":"510","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"setting":"both","billing_class":"professional"}]},{"description":"OBTAINING SCREEN PAP SMEAR-MMA","code_information":[{"code":"2905181","type":"CDM"},{"code":"519","type":"RC"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"VISIT TO DETERM LDCT ELIG","code_information":[{"code":"2905182","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0296","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"professional"}]},{"description":"SELF-MGMT ED & TRAINING-MMA","code_information":[{"code":"2905185","type":"CDM"},{"code":"519","type":"RC"},{"code":"98960","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"NEUROMUSCULAR REED EA 15-MMA","code_information":[{"code":"2905186","type":"CDM"},{"code":"519","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.75,"setting":"both","billing_class":"professional"}]},{"description":"HUMAN IG IM VACCINE-MMA","code_information":[{"code":"2905187","type":"CDM"},{"code":"636","type":"RC"},{"code":"90281","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.5,"setting":"both","billing_class":"facility"},{"gross_charge":107.5,"setting":"both","billing_class":"professional"}]},{"description":"DECLOT VASCULAR DEVICE-MMA","code_information":[{"code":"2905188","type":"CDM"},{"code":"510","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED SKIN PROCEDURE-MMA","code_information":[{"code":"2905189","type":"CDM"},{"code":"510","type":"RC"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY OF NERVE-MMA","code_information":[{"code":"2905190","type":"CDM"},{"code":"510","type":"RC"},{"code":"64795","type":"HCPCS"}],"standard_charges":[{"gross_charge":2074.75,"setting":"both","billing_class":"professional"}]},{"description":"SQ INJ FILLING MATERIAL-MMA","code_information":[{"code":"2905191","type":"CDM"},{"code":"510","type":"RC"},{"code":"11950","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.25,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPSYCH TST AUTO RESULT-MMA","code_information":[{"code":"2905195","type":"CDM"},{"code":"519","type":"RC"},{"code":"96146","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.25,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRANIAL NRV BIL-MMA","code_information":[{"code":"2905196","type":"CDM"},{"code":"510","type":"RC"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"setting":"both","billing_class":"professional"}]},{"description":"ELECTRO HEARING AID TEST-MMA","code_information":[{"code":"2905200","type":"CDM"},{"code":"519","type":"RC"},{"code":"92595","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID EXAM ONE EAR-MMA","code_information":[{"code":"2905201","type":"CDM"},{"code":"519","type":"RC"},{"code":"92590","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.75,"setting":"both","billing_class":"professional"}]},{"description":"APHASIA ASSESSMENT PER HR-MMA","code_information":[{"code":"2905202","type":"CDM"},{"code":"519","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"COGNITIVE PERFORMANCE TEST-MMA","code_information":[{"code":"2905203","type":"CDM"},{"code":"519","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROBEHAVIOR STATUS EXAM-MMA","code_information":[{"code":"2905204","type":"CDM"},{"code":"519","type":"RC"},{"code":"96121","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCHOLOGICAL EVAL 1ST HR-MMA","code_information":[{"code":"2905205","type":"CDM"},{"code":"519","type":"RC"},{"code":"96130","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.25,"setting":"both","billing_class":"professional"}]},{"description":"PSYCHOLOG EVAL EA ADDL HR-MMA","code_information":[{"code":"2905206","type":"CDM"},{"code":"519","type":"RC"},{"code":"96131","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPSYCH EVAL 1ST HR-MMA","code_information":[{"code":"2905207","type":"CDM"},{"code":"519","type":"RC"},{"code":"96132","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPSYCH EVAL EA ADDL HR-MMA","code_information":[{"code":"2905208","type":"CDM"},{"code":"519","type":"RC"},{"code":"96133","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPSYCH TST/SC 1ST 30M-MMA","code_information":[{"code":"2905209","type":"CDM"},{"code":"519","type":"RC"},{"code":"96136","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"NEUROPSYCH TST/SC ADDL 30M-MMA","code_information":[{"code":"2905210","type":"CDM"},{"code":"519","type":"RC"},{"code":"96137","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"professional"}]},{"description":"NEUROP TST BY TECH 1ST 30M-MMA","code_information":[{"code":"2905211","type":"CDM"},{"code":"510","type":"RC"},{"code":"96138","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"NEUROP TST BY TECH ADD 30M-MMA","code_information":[{"code":"2905212","type":"CDM"},{"code":"510","type":"RC"},{"code":"96139","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"LACTATION CLASS-MMA","code_information":[{"code":"2905213","type":"CDM"},{"code":"519","type":"RC"},{"code":"S9443","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"professional"}]},{"description":"GROUP HEALTH ED","code_information":[{"code":"2905214","type":"CDM"},{"code":"519","type":"RC"},{"code":"99078","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF RADIUS-MMA","code_information":[{"code":"2905215","type":"CDM"},{"code":"510","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TREAT FX OF ULNA W MANIP-MMA","code_information":[{"code":"2905216","type":"CDM"},{"code":"510","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"RAPID DESENSITIZATION-MMA","code_information":[{"code":"2905217","type":"CDM"},{"code":"519","type":"RC"},{"code":"95180","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"professional"}]},{"description":"INGEST CHALLENGE ADDL 60M-MMA","code_information":[{"code":"2905218","type":"CDM"},{"code":"519","type":"RC"},{"code":"95079","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND NON OB TRANSV-MMA","code_information":[{"code":"2905219","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.25,"setting":"both","billing_class":"facility"},{"gross_charge":160.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND PELVIC COMPLETE-MMA","code_information":[{"code":"2905220","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.75,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND <14WKS SNGL FET-MMA","code_information":[{"code":"2905221","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"facility"},{"gross_charge":133.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND <14WKS ADDL FET-MMA","code_information":[{"code":"2905222","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND >=14WKS SGL FET-MMA","code_information":[{"code":"2905223","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.5,"setting":"both","billing_class":"facility"},{"gross_charge":166.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND >=14WKS ADD FET-MMA","code_information":[{"code":"2905224","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":78.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND 1MMA","code_information":[{"code":"2905225","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.25,"setting":"both","billing_class":"facility"},{"gross_charge":241.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"FET BIOPHY W/O NONSTR TST-MMA","code_information":[{"code":"2905226","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.75,"setting":"both","billing_class":"facility"},{"gross_charge":102.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND TRANSVAG-MMA","code_information":[{"code":"2905227","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"facility"},{"gross_charge":124.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SPORTS PHYSICAL","code_information":[{"code":"2905237","type":"CDM"},{"code":"519","type":"RC"},{"code":"99429","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED ORL SERVICE/PX-MMA","code_information":[{"code":"2905238","type":"CDM"},{"code":"510","type":"RC"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.75,"setting":"both","billing_class":"professional"}]},{"description":"BINOCULAR VISION EXAM-MMA","code_information":[{"code":"2905239","type":"CDM"},{"code":"510","type":"RC"},{"code":"92060","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"professional"}]},{"description":"VISUAL FIELD EXAM-MMA","code_information":[{"code":"2905240","type":"CDM"},{"code":"510","type":"RC"},{"code":"92083","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"setting":"both","billing_class":"professional"}]},{"description":"INTERM VISUAL FIELD EXAM-MMA","code_information":[{"code":"2905241","type":"CDM"},{"code":"510","type":"RC"},{"code":"92082","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"BASIC LIFE DISABILITY EXAM","code_information":[{"code":"2905242","type":"CDM"},{"code":"519","type":"RC"},{"code":"99450","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG SERVICE-MMA","code_information":[{"code":"2905248","type":"CDM"},{"code":"519","type":"RC"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG SERVICE-MMA","code_information":[{"code":"2905249","type":"CDM"},{"code":"519","type":"RC"},{"code":"99358","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG SERV ADDL-MMA","code_information":[{"code":"2905250","type":"CDM"},{"code":"519","type":"RC"},{"code":"99359","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 5-6 REGNS-MMA","code_information":[{"code":"2905251","type":"CDM"},{"code":"510","type":"RC"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OSTEOPATHIC MAN 7-8 REGNS-MMA","code_information":[{"code":"2905252","type":"CDM"},{"code":"510","type":"RC"},{"code":"98928","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OSTEOPATHIC MAN 9-10 REGNS-MMA","code_information":[{"code":"2905253","type":"CDM"},{"code":"510","type":"RC"},{"code":"98929","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"COORDINATED CARE FEE INIT-MMA","code_information":[{"code":"2905254","type":"CDM"},{"code":"519","type":"RC"},{"code":"G9001","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG INPT EVAL ADD 15M-MMA","code_information":[{"code":"2905255","type":"CDM"},{"code":"960","type":"RC"},{"code":"G0316","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"professional"}]},{"description":"COORDINATED CARE-MMA","code_information":[{"code":"2905256","type":"CDM"},{"code":"519","type":"RC"},{"code":"G9002","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"COORDINATED CARE-MMA","code_information":[{"code":"2905257","type":"CDM"},{"code":"519","type":"RC"},{"code":"G9007","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"COORDINATED CARE-MMA","code_information":[{"code":"2905258","type":"CDM"},{"code":"519","type":"RC"},{"code":"G9008","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"END OF LIFE COUNSELING-MMA","code_information":[{"code":"2905259","type":"CDM"},{"code":"519","type":"RC"},{"code":"S0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"SELF-MGMT ED-MMA","code_information":[{"code":"2905260","type":"CDM"},{"code":"519","type":"RC"},{"code":"98961","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"SELF-MGMT ED-MMA","code_information":[{"code":"2905261","type":"CDM"},{"code":"519","type":"RC"},{"code":"98962","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"HC PRO PHONE CALL-MMA","code_information":[{"code":"2905262","type":"CDM"},{"code":"519","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"HC PRO PHONE CALL-MMA","code_information":[{"code":"2905263","type":"CDM"},{"code":"519","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.75,"setting":"both","billing_class":"professional"}]},{"description":"HC PRO PHONE CALL-MMA","code_information":[{"code":"2905264","type":"CDM"},{"code":"519","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX CH CARE W/O PT VISIT-MMA","code_information":[{"code":"2905265","type":"CDM"},{"code":"519","type":"RC"},{"code":"99487","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPLX CH CARE ADDL 30M-MMA","code_information":[{"code":"2905266","type":"CDM"},{"code":"519","type":"RC"},{"code":"99489","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2905267","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2905268","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID-MMA","code_information":[{"code":"2905270","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"setting":"both","billing_class":"professional"}]},{"description":"ASSMT & CARE PLANNING-MMA","code_information":[{"code":"2905271","type":"CDM"},{"code":"510","type":"RC"},{"code":"99483","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.5,"setting":"both","billing_class":"professional"}]},{"description":"PATCH OR APPLICATION TEST-MMA","code_information":[{"code":"2905274","type":"CDM"},{"code":"519","type":"RC"},{"code":"95044","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"MICROFLUID ANALY TEARS-MMA","code_information":[{"code":"2905275","type":"CDM"},{"code":"300","type":"RC"},{"code":"83861","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"LIMITED VISUAL EXAM-MMA","code_information":[{"code":"2905279","type":"CDM"},{"code":"510","type":"RC"},{"code":"92081","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"CORNEAL TOPOGRAPHY-MMA","code_information":[{"code":"2905280","type":"CDM"},{"code":"510","type":"RC"},{"code":"92025","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"professional"}]},{"description":"OPHTHALMIC BIOMETRY-MMA","code_information":[{"code":"2905281","type":"CDM"},{"code":"510","type":"RC"},{"code":"92136","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","billing_class":"professional"}]},{"description":"LENS FITTING FOR TX-MMA","code_information":[{"code":"2905282","type":"CDM"},{"code":"519","type":"RC"},{"code":"92071","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM NEW PT-MMA","code_information":[{"code":"2905283","type":"CDM"},{"code":"510","type":"RC"},{"code":"92004","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM NEW PT-MMA","code_information":[{"code":"2905284","type":"CDM"},{"code":"510","type":"RC"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM & TX-MMA","code_information":[{"code":"2905285","type":"CDM"},{"code":"510","type":"RC"},{"code":"92014","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.5,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM EST PT-MMA","code_information":[{"code":"2905286","type":"CDM"},{"code":"510","type":"RC"},{"code":"92012","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"professional"}]},{"description":"SP REFRACTION-MMA","code_information":[{"code":"2905287","type":"CDM"},{"code":"519","type":"RC"},{"code":"92015","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION-MMA","code_information":[{"code":"2905288","type":"CDM"},{"code":"510","type":"RC"},{"code":"67801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC CHALAZION-MMA","code_information":[{"code":"2905289","type":"CDM"},{"code":"510","type":"RC"},{"code":"67805","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC CHALAZION,SNGL-MMA","code_information":[{"code":"2905290","type":"CDM"},{"code":"510","type":"RC"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DILATE TEAR DUCT OPENING-MMA","code_information":[{"code":"2905291","type":"CDM"},{"code":"510","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REM FB CONJUNCTIVA-MMA","code_information":[{"code":"2905292","type":"CDM"},{"code":"510","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SEVER ADHESIONS-MMA","code_information":[{"code":"2905293","type":"CDM"},{"code":"510","type":"RC"},{"code":"65860","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"UNL PROC ANT EYE-MMA","code_information":[{"code":"2905294","type":"CDM"},{"code":"510","type":"RC"},{"code":"66999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2458.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"LASER SURGERY EYE STRNDS-MMA","code_information":[{"code":"2905295","type":"CDM"},{"code":"510","type":"RC"},{"code":"67031","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"setting":"both","billing_class":"professional"}]},{"description":"SERIAL TONOMETRY-MMA","code_information":[{"code":"2905296","type":"CDM"},{"code":"519","type":"RC"},{"code":"92100","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"SWIMPLUG","code_information":[{"code":"2905297","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"XEOMIN 100 UNITS","code_information":[{"code":"2905299","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0588","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.5,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"FUNDUS PHOTOGRAPHY-MMA","code_information":[{"code":"2905300","type":"CDM"},{"code":"510","type":"RC"},{"code":"92250","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"professional"}]},{"description":"GONIOSCOPY-MMA","code_information":[{"code":"2905310","type":"CDM"},{"code":"519","type":"RC"},{"code":"92020","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"ICUT ALLERGY TITRATE ARBRN-MMA","code_information":[{"code":"2905311","type":"CDM"},{"code":"519","type":"RC"},{"code":"95027","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"ETONOGESTREL/NEXPLANON","code_information":[{"code":"2905312","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1224.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"MIRENA 52mg","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"2905313","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7298","type":"HCPCS"},{"code":"50419042301","type":"NDC"}],"standard_charges":[{"gross_charge":5783.95,"setting":"both","billing_class":"facility"}]},{"description":"LEVONORGESTREL/MIRENA","code_information":[{"code":"2905313","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.25,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1236.25,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"INTRAUT COPPER/PARAGARD","code_information":[{"code":"2905314","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.5,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1299.5,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"LEVONORGESTR/SKYLA","code_information":[{"code":"2905315","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.5,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1142.5,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"KYLEENA","code_information":[{"code":"2905316","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7296","type":"HCPCS"}],"standard_charges":[{"gross_charge":1469.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1469.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"LEVONORGESTREL/LILETTA","code_information":[{"code":"2905317","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7297","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.75,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":955.75,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"TREAT HUMERUS FX W/MAN-MMA","code_information":[{"code":"2905320","type":"CDM"},{"code":"510","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ULTRASOUND CORNEAL-MMA","code_information":[{"code":"2905321","type":"CDM"},{"code":"510","type":"RC"},{"code":"76514","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC ARM/ELBOW <3CM-MMA","code_information":[{"code":"2905322","type":"CDM"},{"code":"510","type":"RC"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1932.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"XRAY ENTIRE SPI 6/> VW-MMA","code_information":[{"code":"2905323","type":"CDM"},{"code":"510","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-MMA","code_information":[{"code":"2905324","type":"CDM"},{"code":"510","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"OPHTHAL MUCOUS MEMBR TST-MMA","code_information":[{"code":"2905325","type":"CDM"},{"code":"924","type":"RC"},{"code":"95060","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.5,"setting":"both","billing_class":"professional"}]},{"description":"AFTER CATARACT LASER SUR-MMA","code_information":[{"code":"2905326","type":"CDM"},{"code":"510","type":"RC"},{"code":"66821","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.5,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG CLINCL STAFF SVC-MMA","code_information":[{"code":"2905327","type":"CDM"},{"code":"519","type":"RC"},{"code":"99415","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF IRIS LASER-MMA","code_information":[{"code":"2905328","type":"CDM"},{"code":"510","type":"RC"},{"code":"66761","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"setting":"both","billing_class":"professional"}]},{"description":"SUBCONJUNCTIVAL INJ-MMA","code_information":[{"code":"2905329","type":"CDM"},{"code":"510","type":"RC"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.25,"setting":"both","billing_class":"professional"}]},{"description":"EKG INIT PREVENT INT/REP-MMA","code_information":[{"code":"2905330","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0403","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL TAG-MMA","code_information":[{"code":"2905331","type":"CDM"},{"code":"510","type":"RC"},{"code":"46220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SACROILIAC JNTS-MMA","code_information":[{"code":"2905332","type":"CDM"},{"code":"510","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.75,"setting":"both","billing_class":"professional"}]},{"description":"CLOSE TEAR DUCT OPENING-MMA","code_information":[{"code":"2905333","type":"CDM"},{"code":"510","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"N BLOCK INJ  OCCIP-MMA","code_information":[{"code":"2905334","type":"CDM"},{"code":"510","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"MUSCLE TEST 2 LIMBS-MMA","code_information":[{"code":"2905335","type":"CDM"},{"code":"510","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 3 LIMBS-MMA","code_information":[{"code":"2905336","type":"CDM"},{"code":"510","type":"RC"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 4 LIMBS-MMA","code_information":[{"code":"2905337","type":"CDM"},{"code":"510","type":"RC"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.25,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH DIAGNOSTIC EVAL-MMA","code_information":[{"code":"2905338","type":"CDM"},{"code":"519","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH DX EVAL W/MED SRVCS-MMA","code_information":[{"code":"2905339","type":"CDM"},{"code":"519","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.75,"setting":"both","billing_class":"professional"}]},{"description":"PSYTX W PT 30MIN-MMA","code_information":[{"code":"2905340","type":"CDM"},{"code":"519","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"FAM PSYTX W/O PT 50MIN-MMA","code_information":[{"code":"2905341","type":"CDM"},{"code":"519","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"SLIT LAMP PHOTO-MMA","code_information":[{"code":"2905342","type":"CDM"},{"code":"510","type":"RC"},{"code":"92285","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX <=50SQ CM-MMA","code_information":[{"code":"2905343","type":"CDM"},{"code":"510","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.25,"setting":"both","billing_class":"professional"}]},{"description":"AMOXICILLIN 400MG/5ML-MMA","code_information":[{"code":"2905344","type":"CDM"},{"code":"637","type":"RC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"TRABECULOPLASTY LASER SURG-MMA","code_information":[{"code":"2905345","type":"CDM"},{"code":"510","type":"RC"},{"code":"65855","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SHOULDER ARTHOGR INJ-MMA","code_information":[{"code":"2905346","type":"CDM"},{"code":"510","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHROGR INJ-MMA","code_information":[{"code":"2905347","type":"CDM"},{"code":"510","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR C/T INJ-MMA","code_information":[{"code":"2905348","type":"CDM"},{"code":"510","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR L/S INJ-MMA","code_information":[{"code":"2905349","type":"CDM"},{"code":"510","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ-MMA","code_information":[{"code":"2905350","type":"CDM"},{"code":"510","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ SNGL LVL-MMA","code_information":[{"code":"2905351","type":"CDM"},{"code":"510","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ EA ADDL LVL-MMA","code_information":[{"code":"2905352","type":"CDM"},{"code":"510","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.75,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER II/IH NRV INJ-MMA","code_information":[{"code":"2905353","type":"CDM"},{"code":"510","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.25,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IMG INJ-MMA","code_information":[{"code":"2905354","type":"CDM"},{"code":"510","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IM ADD LVL-MMA","code_information":[{"code":"2905355","type":"CDM"},{"code":"510","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.25,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S SNGL LVL-MMA","code_information":[{"code":"2905356","type":"CDM"},{"code":"510","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S EA ADDL LVL-MMA","code_information":[{"code":"2905357","type":"CDM"},{"code":"510","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 1 LVL-MMA","code_information":[{"code":"2905358","type":"CDM"},{"code":"510","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 2 LVL-MMA","code_information":[{"code":"2905359","type":"CDM"},{"code":"510","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.75,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 3 LVL-MMA","code_information":[{"code":"2905360","type":"CDM"},{"code":"510","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 1 LVL-MMA","code_information":[{"code":"2905361","type":"CDM"},{"code":"510","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.75,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 2 LVL-MMA","code_information":[{"code":"2905362","type":"CDM"},{"code":"510","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.5,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 3 LVL-MMA","code_information":[{"code":"2905363","type":"CDM"},{"code":"510","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES SPHEN GANGL INJ-MMA","code_information":[{"code":"2905364","type":"CDM"},{"code":"510","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.75,"setting":"both","billing_class":"professional"}]},{"description":"ANES STELL GANGL INJ-MMA","code_information":[{"code":"2905365","type":"CDM"},{"code":"510","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","billing_class":"professional"}]},{"description":"NB HYPOGAS PLXS INJ-MMA","code_information":[{"code":"2905366","type":"CDM"},{"code":"510","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES LMBR/THRC INJ-MMA","code_information":[{"code":"2905367","type":"CDM"},{"code":"510","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES CELIAC PLXS INJ-MMA","code_information":[{"code":"2905368","type":"CDM"},{"code":"510","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT-MMA","code_information":[{"code":"2905369","type":"CDM"},{"code":"510","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2178.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT ADDL-MMA","code_information":[{"code":"2905370","type":"CDM"},{"code":"510","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT-MMA","code_information":[{"code":"2905371","type":"CDM"},{"code":"510","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2175.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT ADDL-MMA","code_information":[{"code":"2905372","type":"CDM"},{"code":"510","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.25,"setting":"both","billing_class":"professional"}]},{"description":"BLINKI REFLEX TST-MMA","code_information":[{"code":"2905374","type":"CDM"},{"code":"510","type":"RC"},{"code":"95933","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"MD SUPV HH PT 30MMA","code_information":[{"code":"2905375","type":"CDM"},{"code":"519","type":"RC"},{"code":"G0181","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/O PR-MMA","code_information":[{"code":"2905377","type":"CDM"},{"code":"510","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.75,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/ PR-MMA","code_information":[{"code":"2905378","type":"CDM"},{"code":"510","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.25,"setting":"both","billing_class":"professional"}]},{"description":"ALYS NEUROST COMPL W/ PR-MMA","code_information":[{"code":"2905379","type":"CDM"},{"code":"510","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EAR WAX-MMA","code_information":[{"code":"2905380","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EXC CYST/GANGLION TOES-MMA","code_information":[{"code":"2905381","type":"CDM"},{"code":"510","type":"RC"},{"code":"28092","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.25,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M SVC 5-10M-MMA","code_information":[{"code":"2905382","type":"CDM"},{"code":"510","type":"RC"},{"code":"99421","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M SVC 11-20M-MMA","code_information":[{"code":"2905383","type":"CDM"},{"code":"510","type":"RC"},{"code":"99422","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M 21MMA","code_information":[{"code":"2905384","type":"CDM"},{"code":"510","type":"RC"},{"code":"99423","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOTE EVAL OF IMAGE-MMA","code_information":[{"code":"2905385","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2010","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"BRIEF COMM TECH-BASED SVC-MMA","code_information":[{"code":"2905386","type":"CDM"},{"code":"510","type":"RC"},{"code":"98016","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW LOW 30 MIN-MMA","code_information":[{"code":"2905388","type":"CDM"},{"code":"960","type":"RC"},{"code":"98009","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW MOD 45 MIN-MMA","code_information":[{"code":"2905389","type":"CDM"},{"code":"960","type":"RC"},{"code":"98010","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW SF 15 MIN-MMA","code_information":[{"code":"2905390","type":"CDM"},{"code":"960","type":"RC"},{"code":"98008","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL NEW E/M SF 15MIN-MMA","code_information":[{"code":"2905392","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M LOW 30MIN-MMA","code_information":[{"code":"2905393","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M LEV 1-MMA","code_information":[{"code":"2905394","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL EST E/M SF 10MIN-MMA","code_information":[{"code":"2905395","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M LOW 20MIN-MMA","code_information":[{"code":"2905396","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M MOD 30MIN-MMA","code_information":[{"code":"2905397","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M HIGH 40MIN-MMA","code_information":[{"code":"2905398","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"SP VIRTUAL/PHONE LEV 2 NEW-MMA","code_information":[{"code":"2905401","type":"CDM"},{"code":"990","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.69,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 3 NEW-MMA","code_information":[{"code":"2905402","type":"CDM"},{"code":"990","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.94,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 1 EST-MMA","code_information":[{"code":"2905403","type":"CDM"},{"code":"990","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.4,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 2 EST-MMA","code_information":[{"code":"2905404","type":"CDM"},{"code":"990","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 3 EST-MMA","code_information":[{"code":"2905405","type":"CDM"},{"code":"990","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.94,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 4 EST-MMA","code_information":[{"code":"2905406","type":"CDM"},{"code":"990","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.69,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 5 EST-MMA","code_information":[{"code":"2905407","type":"CDM"},{"code":"990","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.19,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE NEW E/M SF 15MIN-MMA","code_information":[{"code":"2905409","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M LOW 30MIN-MMA","code_information":[{"code":"2905410","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.75,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M MOD 45MIN-MMA","code_information":[{"code":"2905411","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.25,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M HIGH 60MIN-MMA","code_information":[{"code":"2905412","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.25,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M LEV 1-MMA","code_information":[{"code":"2905413","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE EST E/M SF 10MIN-MMA","code_information":[{"code":"2905414","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M LOW 20MIN-MMA","code_information":[{"code":"2905415","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.75,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M MOD 30MIN-MMA","code_information":[{"code":"2905416","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.75,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M HIGH 40MIN-MMA","code_information":[{"code":"2905417","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"VIRTUAL NEW E/M MOD 45MIN-MMA","code_information":[{"code":"2905419","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"SP VIRTUAL/PHONE LEV 4 NEW-MMA","code_information":[{"code":"2905420","type":"CDM"},{"code":"990","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.06,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE PSYTX W PT 30MIN-MMA","code_information":[{"code":"2905421","type":"CDM"},{"code":"519","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE PSYTX W PT 45MIN-MMA","code_information":[{"code":"2905422","type":"CDM"},{"code":"519","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE PSYTX W PT 60MIN-MMA","code_information":[{"code":"2905423","type":"CDM"},{"code":"519","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE FAM PSYTX W/O PT 50M-MMA","code_information":[{"code":"2905424","type":"CDM"},{"code":"519","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE FAM PSY TX 45MIN-MMA","code_information":[{"code":"2905425","type":"CDM"},{"code":"519","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE GROUP PSY TX-MMA","code_information":[{"code":"2905426","type":"CDM"},{"code":"519","type":"RC"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"IV INFUSION INIT 31-60M-MMA","code_information":[{"code":"2905427","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"},{"gross_charge":200.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"LACRIMAL PUNCTA SNIP-MMA","code_information":[{"code":"2905428","type":"CDM"},{"code":"510","type":"RC"},{"code":"68440","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"OPSCPY EXT W/ SCL DEP-MMA","code_information":[{"code":"2905429","type":"CDM"},{"code":"510","type":"RC"},{"code":"92201","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"VIRTUAL PREV NEW INFANT-MMA","code_information":[{"code":"2905430","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 1-4YR-MMA","code_information":[{"code":"2905431","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 5-11YR-MMA","code_information":[{"code":"2905432","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 12-17YR-MMA","code_information":[{"code":"2905433","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 18-39YR-MMA","code_information":[{"code":"2905434","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 40-64YR-MMA","code_information":[{"code":"2905435","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 65MMA","code_information":[{"code":"2905436","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST INFANT-MMA","code_information":[{"code":"2905437","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 1-4YR-MMA","code_information":[{"code":"2905438","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 5-11YR-MMA","code_information":[{"code":"2905439","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 12-17YR-MMA","code_information":[{"code":"2905440","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 18-39YR-MMA","code_information":[{"code":"2905441","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 40-64YR-MMA","code_information":[{"code":"2905442","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 65MMA","code_information":[{"code":"2905443","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL TOB COUNSEL 3-10M-MMA","code_information":[{"code":"2905444","type":"CDM"},{"code":"510","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL TOB COUNSEL >10M-MMA","code_information":[{"code":"2905445","type":"CDM"},{"code":"510","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL QUAL NONMD 5-10M-MMA","code_information":[{"code":"2905446","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2061","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL QUAL NONMD 11-20M-MMA","code_information":[{"code":"2905447","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2062","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL QUAL NONMD  >21M-MMA","code_information":[{"code":"2905448","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2063","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL TCM W/IN 14D-MMA","code_information":[{"code":"2905449","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL TCM W/IN 7D-MMA","code_information":[{"code":"2905450","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"BX SOFT TISSUE THIGH/KNEE-MMA","code_information":[{"code":"2905451","type":"CDM"},{"code":"510","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL ANNUAL WLLNSS INIT-MMA","code_information":[{"code":"2905452","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL ANNUAL WLLNSS SBSQ-MMA","code_information":[{"code":"2905453","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NEW E/M HIGH 60MIN-MMA","code_information":[{"code":"2905454","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"SP VIRTUAL/PHONE LEV 5 NEW-MMA","code_information":[{"code":"2905455","type":"CDM"},{"code":"990","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.06,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PXYTX CRISIS INIT 60M-MMA","code_information":[{"code":"2905456","type":"CDM"},{"code":"519","type":"RC"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.25,"setting":"both","billing_class":"professional"}]},{"description":"PSYTX CRISIS EA ADDL 30M-MMA","code_information":[{"code":"2905457","type":"CDM"},{"code":"519","type":"RC"},{"code":"90840","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"PHONE PSYTX CRISIS INI 60M-MMA","code_information":[{"code":"2905458","type":"CDM"},{"code":"519","type":"RC"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE PSYTX CRISIS ADD 30M-MMA","code_information":[{"code":"2905459","type":"CDM"},{"code":"519","type":"RC"},{"code":"90840","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"POSITIONAL NYSTAGMUS TST-MMA","code_information":[{"code":"2905460","type":"CDM"},{"code":"510","type":"RC"},{"code":"92542","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"ONABOTULINUMTOXINA 50 UN INJ","code_information":[{"code":"2905461","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.25,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"XEOMIN 50 UNITS","code_information":[{"code":"2905462","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0588","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.75,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"ACUPUNCT W/O STIM 15M-MMA","code_information":[{"code":"2905464","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97810","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"ACUPUNCT W/O STIM ADDL 15M-MMA","code_information":[{"code":"2905465","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97811","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"A-SCAN EYE US W IOL MEASR-MMA","code_information":[{"code":"2905466","type":"CDM"},{"code":"402","type":"RC"},{"code":"76519","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"setting":"both","billing_class":"professional"}]},{"description":"OPSCPY EXT W/O SCL DEP-MMA","code_information":[{"code":"2905467","type":"CDM"},{"code":"510","type":"RC"},{"code":"92202","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"IMPL DRG PUMP NO REPROGRAM-MMA","code_information":[{"code":"2905468","type":"CDM"},{"code":"361","type":"RC"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REPROGRAM-MMA","code_information":[{"code":"2905469","type":"CDM"},{"code":"361","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL/REPRO-MMA","code_information":[{"code":"2905470","type":"CDM"},{"code":"361","type":"RC"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.25,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL-MMA","code_information":[{"code":"2905471","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.5,"setting":"both","billing_class":"professional"}]},{"description":"CORNEA SCRAPING SMEAR/CUL-MMA","code_information":[{"code":"2905472","type":"CDM"},{"code":"510","type":"RC"},{"code":"65430","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"N BLOCK INJ TRIGEMINAL BIL-MMA","code_information":[{"code":"2905473","type":"CDM"},{"code":"510","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"N BLOCK OTH PERIPHERAL BIL-MMA","code_information":[{"code":"2905474","type":"CDM"},{"code":"510","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"AMNIOTIC GRAFT-MMA","code_information":[{"code":"2905475","type":"CDM"},{"code":"510","type":"RC"},{"code":"65778","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PARACENTESIS ANT CHAMB-MMA","code_information":[{"code":"2905476","type":"CDM"},{"code":"510","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"BLEPHAROPLASTY UPPER LID-MMA","code_information":[{"code":"2905477","type":"CDM"},{"code":"510","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.75,"setting":"both","billing_class":"professional"}]},{"description":"REM CORNEAL EPI-MMA","code_information":[{"code":"2905478","type":"CDM"},{"code":"510","type":"RC"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":981.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EPILATION,FORCEPS-MMA","code_information":[{"code":"2905479","type":"CDM"},{"code":"510","type":"RC"},{"code":"67820","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"EVAC MEIBOMIAN GLND,MANUAL-MMA","code_information":[{"code":"2905480","type":"CDM"},{"code":"761","type":"RC"},{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"EVAC MEIBOMIAN GLND,AUTO-MMA","code_information":[{"code":"2905481","type":"CDM"},{"code":"761","type":"RC"},{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LESION-MMA","code_information":[{"code":"2905482","type":"CDM"},{"code":"510","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"TENON CAPSULE INJ-MMA","code_information":[{"code":"2905483","type":"CDM"},{"code":"510","type":"RC"},{"code":"67515","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.5,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"SP PACK,TECNIS/ALCON TORIC-MMA","code_information":[{"code":"2905484","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":1078.0,"setting":"both","billing_class":"professional"}]},{"description":"SP PACK,SYMFONY/PANIOPTIX-MMA","code_information":[{"code":"2905487","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":1555.0,"setting":"both","billing_class":"professional"}]},{"description":"NUCALA/MEPOLUZUMAB 100MG-MMA","code_information":[{"code":"2905489","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4622.75,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"HARVEST CULTURED SK GRAFT-MMA","code_information":[{"code":"2905490","type":"CDM"},{"code":"510","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1957.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA BIL-MMA","code_information":[{"code":"2905491","type":"CDM"},{"code":"510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPAIR ENTROPION SUTURE-MMA","code_information":[{"code":"2905492","type":"CDM"},{"code":"510","type":"RC"},{"code":"67921","type":"HCPCS"}],"standard_charges":[{"gross_charge":2503.25,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY PALATE UVULA-MMA","code_information":[{"code":"2905493","type":"CDM"},{"code":"510","type":"RC"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.0,"setting":"both","billing_class":"professional"}]},{"description":"CAREGIVER FOCUS HEALTH RSK-MMA","code_information":[{"code":"2905494","type":"CDM"},{"code":"519","type":"RC"},{"code":"96161","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HORMONE SQ-MMA","code_information":[{"code":"2905495","type":"CDM"},{"code":"510","type":"RC"},{"code":"11980","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REPAIR EXTENSIVE ECTROPIAN-MMA","code_information":[{"code":"2905496","type":"CDM"},{"code":"510","type":"RC"},{"code":"67917","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF PELVIS 3V-MMA","code_information":[{"code":"2905497","type":"CDM"},{"code":"510","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"INC CONJUNCTIVA DRAINAGE-MMA","code_information":[{"code":"2905498","type":"CDM"},{"code":"510","type":"RC"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSC-MMA","code_information":[{"code":"2905499","type":"CDM"},{"code":"510","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1743.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"CHANGE OF BLADDER TUBE-MMA","code_information":[{"code":"2905500","type":"CDM"},{"code":"510","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.25,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"DOPPLER VELOCIMETRY UMBI-MMA","code_information":[{"code":"2905501","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"facility"},{"gross_charge":41.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"DUPLEX ARTERIAL FLOW-MMA","code_information":[{"code":"2905502","type":"CDM"},{"code":"402","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"setting":"both","billing_class":"facility"},{"gross_charge":425.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ULTRASOUND SCROTUM-MMA","code_information":[{"code":"2905503","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.75,"setting":"both","billing_class":"facility"},{"gross_charge":134.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ANES VIA SPHENO CATH-MMA","code_information":[{"code":"2905504","type":"CDM"},{"code":"510","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.75,"setting":"both","billing_class":"professional"}]},{"description":"ADDL SUPPL/STFF DRNG PHE-MMA","code_information":[{"code":"2905505","type":"CDM"},{"code":"519","type":"RC"},{"code":"99072","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"PERQ&ICUT ALLG TST VENOMS-MMA","code_information":[{"code":"2905506","type":"CDM"},{"code":"519","type":"RC"},{"code":"95017","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IMM;SGL STING-MMA","code_information":[{"code":"2905507","type":"CDM"},{"code":"519","type":"RC"},{"code":"95145","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IMM; 2 STING-MMA","code_information":[{"code":"2905508","type":"CDM"},{"code":"519","type":"RC"},{"code":"95146","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IMM; 3 STING-MMA","code_information":[{"code":"2905509","type":"CDM"},{"code":"519","type":"RC"},{"code":"95147","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IMM; 4 STING-MMA","code_information":[{"code":"2905510","type":"CDM"},{"code":"519","type":"RC"},{"code":"95148","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IMM; 5 STING-MMA","code_information":[{"code":"2905511","type":"CDM"},{"code":"519","type":"RC"},{"code":"95149","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"PREP ALLERGEN IMMUN;SGL/M-MMA","code_information":[{"code":"2905512","type":"CDM"},{"code":"519","type":"RC"},{"code":"95165","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"PREP ALLERGEN WHOLE BDY-MMA","code_information":[{"code":"2905513","type":"CDM"},{"code":"519","type":"RC"},{"code":"95170","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"EYE MASK-MMA","code_information":[{"code":"2905514","type":"CDM"},{"code":"519","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"PERC RELEASE DUPUYTREN CON-MMA","code_information":[{"code":"2905515","type":"CDM"},{"code":"510","type":"RC"},{"code":"26040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.25,"setting":"both","billing_class":"professional"}]},{"description":"SP IPL DRY EYE DISEASE-MMA","code_information":[{"code":"2905516","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":312.5,"setting":"both","billing_class":"professional"}]},{"description":"SP IPL ROSACEA-MMA","code_information":[{"code":"2905517","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":375.0,"setting":"both","billing_class":"professional"}]},{"description":"SP IPL HYPERPIGMENT-MMA","code_information":[{"code":"2905518","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":375.0,"setting":"both","billing_class":"professional"}]},{"description":"ALYS IMPLANT W/PRGRM-MMA","code_information":[{"code":"2905519","type":"CDM"},{"code":"510","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.25,"setting":"both","billing_class":"professional"}]},{"description":"ALYS CPLX IMPLANT W/PRGRM-MMA","code_information":[{"code":"2905520","type":"CDM"},{"code":"510","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.25,"setting":"both","billing_class":"professional"}]},{"description":"LOCM ISOVUE 300 50ML VIAL","code_information":[{"code":"2905521","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.75,"setting":"both","billing_class":"facility"},{"gross_charge":286.75,"setting":"both","billing_class":"professional"}]},{"description":"NITROUS OXIDE-MMA","code_information":[{"code":"2905522","type":"CDM"},{"code":"519","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV TRUNK MUSC 1-5-MMA","code_information":[{"code":"2905523","type":"CDM"},{"code":"510","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM HIP-MMA","code_information":[{"code":"2905524","type":"CDM"},{"code":"510","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.5,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-MMA","code_information":[{"code":"2905525","type":"CDM"},{"code":"510","type":"RC"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.25,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-MMA","code_information":[{"code":"2905526","type":"CDM"},{"code":"510","type":"RC"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2430.75,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ENTROPION THERMOCAU-MMA","code_information":[{"code":"2905527","type":"CDM"},{"code":"510","type":"RC"},{"code":"67922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2377.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM BIL HIP-MMA","code_information":[{"code":"2905528","type":"CDM"},{"code":"510","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXPL/TX RADIOCARPAL JNT-MMA","code_information":[{"code":"2905613","type":"CDM"},{"code":"510","type":"RC"},{"code":"25040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3693.25,"setting":"both","billing_class":"professional"}]},{"description":"US OB FOLLOW UP (59)-MMA","code_information":[{"code":"2905617","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.5,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":152.5,"setting":"both","modifiers":"TC|59","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier 59: Distinct Procedural Service"}]},{"description":"FET BIOPHY W/O NONSTR (59)-MMA","code_information":[{"code":"2905618","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.75,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":102.75,"setting":"both","modifiers":"TC|59","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier 59: Distinct Procedural Service"}]},{"description":"SP VIRTUAL/PH PREV EST 1-4-MMA","code_information":[{"code":"2905620","type":"CDM"},{"code":"990","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.19,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRT/PH PREV EST 5-11-MMA","code_information":[{"code":"2905621","type":"CDM"},{"code":"990","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.19,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRT/PH PREV EST 12-17-MMA","code_information":[{"code":"2905622","type":"CDM"},{"code":"990","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"ULTRASOUND ABD LIMITED-MMA","code_information":[{"code":"2905627","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"setting":"both","billing_class":"facility"},{"gross_charge":132.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"FASENRA","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2906001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030","type":"NDC"}],"standard_charges":[{"gross_charge":26311.72,"setting":"both","billing_class":"facility"}]},{"description":"FASENRA 30MG","code_information":[{"code":"2906001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"}],"standard_charges":[{"gross_charge":7308.81,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"XOLAIR 150 MG/ML SUBQ-MMA","code_information":[{"code":"2906002","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"}],"standard_charges":[{"gross_charge":1770.15,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"XOLAIR 75 MG/ML SUBQ-MMA","code_information":[{"code":"2906003","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.5,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":884.5,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"AEP SCRN AUD POTENTL-MMA","code_information":[{"code":"2906008","type":"CDM"},{"code":"510","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.75,"setting":"both","billing_class":"professional"}]},{"description":"AEP HEARING STATUS DET I&R-MMA","code_information":[{"code":"2906009","type":"CDM"},{"code":"510","type":"RC"},{"code":"92651","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"setting":"both","billing_class":"professional"}]},{"description":"AEP THRSHLD EST ML FRQ I&R-MMA","code_information":[{"code":"2906010","type":"CDM"},{"code":"510","type":"RC"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.5,"setting":"both","billing_class":"professional"}]},{"description":"AEP NEURODIAGNOSTIC I&R-MMA","code_information":[{"code":"2906011","type":"CDM"},{"code":"510","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.75,"setting":"both","billing_class":"professional"}]},{"description":"PROLNG OFF/OP E/M EA 15M-MMA","code_information":[{"code":"2906012","type":"CDM"},{"code":"510","type":"RC"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE MGNT 1ST 20M-MMA","code_information":[{"code":"2906013","type":"CDM"},{"code":"510","type":"RC"},{"code":"99490","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE EA ADDL 20M-MMA","code_information":[{"code":"2906014","type":"CDM"},{"code":"510","type":"RC"},{"code":"99439","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"setting":"both","billing_class":"professional"}]},{"description":"ADVANCED DIRECTIVE GUIDNCE-MMA","code_information":[{"code":"2906015","type":"CDM"},{"code":"510","type":"RC"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"NB FEMORAL BIL-MMA","code_information":[{"code":"2906016","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.25,"setting":"both","billing_class":"professional"}]},{"description":"NB FEMORAL LT-MMA","code_information":[{"code":"2906017","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-MMA","code_information":[{"code":"2906018","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY LOWER LEG BIL-MMA","code_information":[{"code":"2906019","type":"CDM"},{"code":"510","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY ANKLE BILATERAL-MMA","code_information":[{"code":"2906020","type":"CDM"},{"code":"510","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CHEMO ANTI-NEOPL SQ/IM-MMA","code_information":[{"code":"2906021","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"setting":"both","billing_class":"facility"},{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ENTROPION EXTENSIVE-MMA","code_information":[{"code":"2906022","type":"CDM"},{"code":"510","type":"RC"},{"code":"67924","type":"HCPCS"}],"standard_charges":[{"gross_charge":2229.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FOOT BILATERAL-MMA","code_information":[{"code":"2906023","type":"CDM"},{"code":"510","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY OF FOOT BIL-MMA","code_information":[{"code":"2906024","type":"CDM"},{"code":"510","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HLTH BHV ASSMT/REASSMT-MMA","code_information":[{"code":"2906026","type":"CDM"},{"code":"510","type":"RC"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.5,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV INT J IND 1ST 30-MMA","code_information":[{"code":"2906027","type":"CDM"},{"code":"510","type":"RC"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.25,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV INVT IND EA ADDL-MMA","code_information":[{"code":"2906028","type":"CDM"},{"code":"510","type":"RC"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FAM 1ST 30-MMA","code_information":[{"code":"2906029","type":"CDM"},{"code":"510","type":"RC"},{"code":"96167","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.25,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNTJ FAM EA ADDL-MMA","code_information":[{"code":"2906030","type":"CDM"},{"code":"510","type":"RC"},{"code":"96168","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.25,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM WO PT 1ST-MMA","code_information":[{"code":"2906031","type":"CDM"},{"code":"510","type":"RC"},{"code":"96170","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM W/O PT EA-MMA","code_information":[{"code":"2906032","type":"CDM"},{"code":"510","type":"RC"},{"code":"96171","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ JOINT/BURSA BIL-MMA","code_information":[{"code":"2906033","type":"CDM"},{"code":"510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"THER INJ  CARP TUNNEL BIL-MMA","code_information":[{"code":"2906034","type":"CDM"},{"code":"510","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTO W FRAGM OF CALCULUS-MMA","code_information":[{"code":"2906035","type":"CDM"},{"code":"510","type":"RC"},{"code":"52325","type":"HCPCS"}],"standard_charges":[{"gross_charge":5558.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPI 4/5 VW-MMA","code_information":[{"code":"2906036","type":"CDM"},{"code":"510","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK BIL-MMA","code_information":[{"code":"2906037","type":"CDM"},{"code":"510","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY EXAM SPI 1 VW-MMA","code_information":[{"code":"2906038","type":"CDM"},{"code":"510","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.25,"setting":"both","billing_class":"professional"}]},{"description":"XOLAIR 300 MG/ML SUBQ-MMA","code_information":[{"code":"2906041","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"}],"standard_charges":[{"gross_charge":3540.3,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":3540.3,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"PRE-PEN 0.25ML SOLUTION-MMA","code_information":[{"code":"2906042","type":"CDM"},{"code":"636","type":"RC"}],"standard_charges":[{"gross_charge":998.75,"setting":"both","billing_class":"professional"}]},{"description":"DUPIXENT 300MG/2ML SYRINGE-MMA","code_information":[{"code":"2906043","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":1170.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"ALTPLASE CATH 1MG(2MG INJ)-MMA","code_information":[{"code":"2906044","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"NJX INTERLAMINAR LMBR/SAC-MMA","code_information":[{"code":"2906599","type":"CDM"},{"code":"510","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.5,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEX DRAINAGE WND-MMA","code_information":[{"code":"2907001","type":"CDM"},{"code":"361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3138.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE MUSC-MMA","code_information":[{"code":"2907002","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE 20CM OR LESS-MMA","code_information":[{"code":"2907003","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.75,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN SINGLE LES-MMA","code_information":[{"code":"2907006","type":"CDM"},{"code":"361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.25,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 1.1-5.0CC-MMA","code_information":[{"code":"2907011","type":"CDM"},{"code":"361","type":"RC"},{"code":"11951","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.75,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 5.1-10.0 CC-MMA","code_information":[{"code":"2907012","type":"CDM"},{"code":"361","type":"RC"},{"code":"11952","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.25,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP ADDL 100 CM-MMA","code_information":[{"code":"2907014","type":"CDM"},{"code":"361","type":"RC"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.75,"setting":"both","billing_class":"professional"}]},{"description":"WND F/N/HF/G 100 SQCM/1%BA-MMA","code_information":[{"code":"2907015","type":"CDM"},{"code":"361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1406.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX OPEN SUPERFICIAL-MMA","code_information":[{"code":"2907016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2937.0,"setting":"both","billing_class":"professional"}]},{"description":"I & D INFECTED BURSA  FOOT-MMA","code_information":[{"code":"2907018","type":"CDM"},{"code":"361","type":"RC"},{"code":"28001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.0,"setting":"both","billing_class":"professional"}]},{"description":"DEEP DIS FT INF SGL BURSA-MMA","code_information":[{"code":"2907019","type":"CDM"},{"code":"361","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.25,"setting":"both","billing_class":"professional"}]},{"description":"DEEP I&D FT INF MULTI AREA-MMA","code_information":[{"code":"2907020","type":"CDM"},{"code":"361","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":4495.25,"setting":"both","billing_class":"professional"}]},{"description":"DEEP INC FT W OP BONE CRTX-MMA","code_information":[{"code":"2907021","type":"CDM"},{"code":"361","type":"RC"},{"code":"28005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4264.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISE FOOT/TOE FASCIA-MMA","code_information":[{"code":"2907022","type":"CDM"},{"code":"361","type":"RC"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":3994.25,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY SQ TOE; SINGLE-MMA","code_information":[{"code":"2907023","type":"CDM"},{"code":"361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.5,"setting":"both","billing_class":"professional"}]},{"description":"REM DEEP FB OF FOOT-MMA","code_information":[{"code":"2907024","type":"CDM"},{"code":"361","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2462.0,"setting":"both","billing_class":"professional"}]},{"description":"TENTMY OP FLEX FT SGL/MULT-MMA","code_information":[{"code":"2907025","type":"CDM"},{"code":"361","type":"RC"},{"code":"28230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.0,"setting":"both","billing_class":"professional"}]},{"description":"MTP JNT CAPSULO EA SGL JNT-MMA","code_information":[{"code":"2907026","type":"CDM"},{"code":"361","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":4106.5,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION HALLUX VALGUS-MMA","code_information":[{"code":"2907027","type":"CDM"},{"code":"361","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":3512.0,"setting":"both","billing_class":"professional"}]},{"description":"CL TX MTP JNT DISLC W ANES-MMA","code_information":[{"code":"2907028","type":"CDM"},{"code":"361","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.25,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JNT DISLC WO ANES-MMA","code_information":[{"code":"2907029","type":"CDM"},{"code":"361","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.25,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JOINT DISL W ANES-MMA","code_information":[{"code":"2907030","type":"CDM"},{"code":"361","type":"RC"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING OF TOES-MMA","code_information":[{"code":"2907031","type":"CDM"},{"code":"361","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.5,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ COMMON DIGIT-MMA","code_information":[{"code":"2907032","type":"CDM"},{"code":"361","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"setting":"both","billing_class":"professional"}]},{"description":"DECOM PLANTAR DIGITAL NERV-MMA","code_information":[{"code":"2907034","type":"CDM"},{"code":"361","type":"RC"},{"code":"64726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND LMT JT-MMA","code_information":[{"code":"2907035","type":"CDM"},{"code":"361","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG OUTPT/OFFICE VIS-MMA","code_information":[{"code":"2907040","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"SPIROMETRY MMA CLIENT","code_information":[{"code":"2907041","type":"CDM"},{"code":"519","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"INC MULTI SQ TOE TENDONS-MMA","code_information":[{"code":"2907042","type":"CDM"},{"code":"361","type":"RC"},{"code":"28011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2299.5,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY NAIL UNIT-MMA","code_information":[{"code":"2907045","type":"CDM"},{"code":"510","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 1.1-2.5 CM-MMA","code_information":[{"code":"2907046","type":"CDM"},{"code":"510","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L ADDL 5CM/<-MMA","code_information":[{"code":"2907047","type":"CDM"},{"code":"510","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN PINCH GRAFT-MMA","code_information":[{"code":"2907048","type":"CDM"},{"code":"510","type":"RC"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-MMA","code_information":[{"code":"2907049","type":"CDM"},{"code":"510","type":"RC"},{"code":"15241","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-MMA","code_information":[{"code":"2907050","type":"CDM"},{"code":"510","type":"RC"},{"code":"15261","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-MMA","code_information":[{"code":"2907051","type":"CDM"},{"code":"510","type":"RC"},{"code":"17270","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.5,"setting":"both","billing_class":"professional"}]},{"description":"S/N/H/F/G LES DIAM>4.0 CM-MMA","code_information":[{"code":"2907052","type":"CDM"},{"code":"510","type":"RC"},{"code":"17276","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE H/N/HF/G-MMA","code_information":[{"code":"2907053","type":"CDM"},{"code":"510","type":"RC"},{"code":"17311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE-MMA","code_information":[{"code":"2907054","type":"CDM"},{"code":"510","type":"RC"},{"code":"17312","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE T/A/L-MMA","code_information":[{"code":"2907055","type":"CDM"},{"code":"510","type":"RC"},{"code":"17313","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.75,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE T/A/L-MMA","code_information":[{"code":"2907056","type":"CDM"},{"code":"510","type":"RC"},{"code":"17314","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.5,"setting":"both","billing_class":"professional"}]},{"description":"MOHS SURG ADDL BLOCK-MMA","code_information":[{"code":"2907057","type":"CDM"},{"code":"510","type":"RC"},{"code":"17315","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE EA ADDL-MMA","code_information":[{"code":"2907139","type":"CDM"},{"code":"510","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.25,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 1.1-2.5 CM-MMA","code_information":[{"code":"2907140","type":"CDM"},{"code":"510","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.25,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 2.6-7.5 CM-MMA","code_information":[{"code":"2907141","type":"CDM"},{"code":"510","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.5,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK EA ADDL 5CM/<-MMA","code_information":[{"code":"2907142","type":"CDM"},{"code":"510","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.75,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 1.1-2.5 CM-MMA","code_information":[{"code":"2907143","type":"CDM"},{"code":"510","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1250.75,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 2.6-7.5 CM-MMA","code_information":[{"code":"2907144","type":"CDM"},{"code":"510","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.5,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG EA ADL 5 CM<MMA","code_information":[{"code":"2907145","type":"CDM"},{"code":"510","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.5,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F1.1-2.5CM-MMA","code_information":[{"code":"2907146","type":"CDM"},{"code":"510","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F2.6-7.5CM-MMA","code_information":[{"code":"2907147","type":"CDM"},{"code":"510","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.25,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F AD 5CM<-MMA","code_information":[{"code":"2907148","type":"CDM"},{"code":"510","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 2.6-7.5 CM-MMA","code_information":[{"code":"2907150","type":"CDM"},{"code":"510","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<-MMA","code_information":[{"code":"2907151","type":"CDM"},{"code":"510","type":"RC"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3094.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TRNK 10.1-30SQCM-MMA","code_information":[{"code":"2907152","type":"CDM"},{"code":"510","type":"RC"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3417.5,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<-MMA","code_information":[{"code":"2907153","type":"CDM"},{"code":"510","type":"RC"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.75,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L10.1-30SQCM-MMA","code_information":[{"code":"2907154","type":"CDM"},{"code":"510","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":3534.0,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F 10SQCM/<-MMA","code_information":[{"code":"2907155","type":"CDM"},{"code":"510","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.0,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F 10.1-30-MMA","code_information":[{"code":"2907156","type":"CDM"},{"code":"510","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR E/N/E/L 10 SQCM<-MMA","code_information":[{"code":"2907157","type":"CDM"},{"code":"510","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":3355.5,"setting":"both","billing_class":"professional"}]},{"description":"TRNFR E/N/E/L10.1-30SQCM-MMA","code_information":[{"code":"2907158","type":"CDM"},{"code":"510","type":"RC"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":3777.75,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F 20 CM/<-MMA","code_information":[{"code":"2907159","type":"CDM"},{"code":"510","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3658.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT EEN & LIPS-MMA","code_information":[{"code":"2907160","type":"CDM"},{"code":"510","type":"RC"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3786.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SK LES-MMA","code_information":[{"code":"2907161","type":"CDM"},{"code":"510","type":"RC"},{"code":"17271","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-MMA","code_information":[{"code":"2907162","type":"CDM"},{"code":"510","type":"RC"},{"code":"17272","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 2.1-3.0CM-MMA","code_information":[{"code":"2907163","type":"CDM"},{"code":"510","type":"RC"},{"code":"17273","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.75,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 3.1-4.0CM-MMA","code_information":[{"code":"2907164","type":"CDM"},{"code":"510","type":"RC"},{"code":"17274","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP TRK/ARM/LEG-MMA","code_information":[{"code":"2907165","type":"CDM"},{"code":"510","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2634.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-MMA","code_information":[{"code":"2907166","type":"CDM"},{"code":"510","type":"RC"},{"code":"17280","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.25,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 1.1-2.0CM-MMA","code_information":[{"code":"2907167","type":"CDM"},{"code":"510","type":"RC"},{"code":"17282","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.25,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 2.1-3.0CM-MMA","code_information":[{"code":"2907168","type":"CDM"},{"code":"510","type":"RC"},{"code":"17283","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO INTRALESIONL UP TO 7-MMA","code_information":[{"code":"2907169","type":"CDM"},{"code":"510","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-CERVICAL-MMA","code_information":[{"code":"2907170","type":"CDM"},{"code":"510","type":"RC"},{"code":"58321","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-UTERINE-MMA","code_information":[{"code":"2907171","type":"CDM"},{"code":"510","type":"RC"},{"code":"58322","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ANY 30.1-60 SQCM-MMA","code_information":[{"code":"2907172","type":"CDM"},{"code":"510","type":"RC"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":5984.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ADDL 30 SQ CM-MMA","code_information":[{"code":"2907173","type":"CDM"},{"code":"510","type":"RC"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.25,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP F/N/HF/G ADDL CM-MMA","code_information":[{"code":"2907174","type":"CDM"},{"code":"510","type":"RC"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.5,"setting":"both","billing_class":"professional"}]},{"description":"MAL LES F/E/E/N/L/M3.1-4.0-MMA","code_information":[{"code":"2907175","type":"CDM"},{"code":"510","type":"RC"},{"code":"17284","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"setting":"both","billing_class":"professional"}]},{"description":"MAL LESF/E/E/N/L/M >4.0 CM-MMA","code_information":[{"code":"2907176","type":"CDM"},{"code":"510","type":"RC"},{"code":"17286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV ECCRINE GLANDS-MMA","code_information":[{"code":"2907179","type":"CDM"},{"code":"510","type":"RC"},{"code":"64650","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODNRV ECRINE GLAND OTH-MMA","code_information":[{"code":"2907180","type":"CDM"},{"code":"510","type":"RC"},{"code":"64653","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.75,"setting":"both","billing_class":"professional"}]},{"description":"ELECT CURRENT THERAPY-MMA","code_information":[{"code":"2907182","type":"CDM"},{"code":"510","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"setting":"both","billing_class":"professional"}]},{"description":"TX CONTOUR DEFECT >10.0 CC-MMA","code_information":[{"code":"2907183","type":"CDM"},{"code":"510","type":"RC"},{"code":"11954","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FOOT COMP-MMA","code_information":[{"code":"2907184","type":"CDM"},{"code":"510","type":"RC"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2574.75,"setting":"both","billing_class":"professional"}]},{"description":"OCULAR INSTR SCREEN BIL-MMA","code_information":[{"code":"2907185","type":"CDM"},{"code":"519","type":"RC"},{"code":"99174","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"OCULAR INSTR SCREEN BIL-MMA","code_information":[{"code":"2907186","type":"CDM"},{"code":"519","type":"RC"},{"code":"99177","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF TOE DISLOCATION-MMA","code_information":[{"code":"2907187","type":"CDM"},{"code":"361","type":"RC"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":4259.5,"setting":"both","billing_class":"professional"}]},{"description":"TRIMMING NAILS-MMA","code_information":[{"code":"2907188","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING UNNA BOOT BIL-MMA","code_information":[{"code":"2907189","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN OUTER EAR CANAL LESN-MMA","code_information":[{"code":"2907191","type":"CDM"},{"code":"361","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE/DRAIN TEAR SAC-MMA","code_information":[{"code":"2907192","type":"CDM"},{"code":"361","type":"RC"},{"code":"68420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2887.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY THORACIC SPINE 4/>VW-MMA","code_information":[{"code":"2907194","type":"CDM"},{"code":"510","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON SHEATH/LIG BIL-MMA","code_information":[{"code":"2907195","type":"CDM"},{"code":"510","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DSTRJ NULYT AGT GNCLR NRV-MMA","code_information":[{"code":"2907196","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2243.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF URETHRA INJURY-MMA","code_information":[{"code":"2907197","type":"CDM"},{"code":"510","type":"RC"},{"code":"53502","type":"HCPCS"}],"standard_charges":[{"gross_charge":4359.5,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-MYOMECTOMY COMPLEX-MMA","code_information":[{"code":"2907198","type":"CDM"},{"code":"510","type":"RC"},{"code":"58546","type":"HCPCS"}],"standard_charges":[{"gross_charge":12099.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOCERV CURETTAGE W/SCOPE-MMA","code_information":[{"code":"2907199","type":"CDM"},{"code":"510","type":"RC"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST COMPLETE BIL-MMA","code_information":[{"code":"2907200","type":"CDM"},{"code":"510","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSED TX VERT FX W/MANJ-MMA","code_information":[{"code":"2907201","type":"CDM"},{"code":"510","type":"RC"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":4703.25,"setting":"both","billing_class":"professional"}]},{"description":"FECAL BLOOD SCRN IMMUNOASSAY","code_information":[{"code":"2907202","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":22.5,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"ASSAY TEST FOR BLOOD FECAL","code_information":[{"code":"2907203","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":20.0,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"REMOVAL INTRANASAL LES INT-MMA","code_information":[{"code":"2907204","type":"CDM"},{"code":"510","type":"RC"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":4780.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL INTRANASAL LES EXT-MMA","code_information":[{"code":"2907205","type":"CDM"},{"code":"510","type":"RC"},{"code":"30118","type":"HCPCS"}],"standard_charges":[{"gross_charge":4433.5,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID FITTING/CHECKING","code_information":[{"code":"2907206","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5011","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"professional"}]},{"description":"HEARING AID MONAURAL BTE","code_information":[{"code":"2907207","type":"CDM"},{"code":"519","type":"RC"},{"code":"V5181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.0,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY SALPINGOSTOMY-MMA","code_information":[{"code":"2907208","type":"CDM"},{"code":"510","type":"RC"},{"code":"58673","type":"HCPCS"}],"standard_charges":[{"gross_charge":7177.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE SHOULDER FORGN BODY-MMA","code_information":[{"code":"2907209","type":"CDM"},{"code":"510","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.25,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JT/BURSA BIL W/US-MMA","code_information":[{"code":"2907210","type":"CDM"},{"code":"510","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAPARO PROC ABDM/PER/OMENT-MMA","code_information":[{"code":"2907211","type":"CDM"},{"code":"510","type":"RC"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":6662.5,"setting":"both","billing_class":"professional"}]},{"description":"DTAP-IPV-HIB-HEPB VACCINE-MMA","code_information":[{"code":"2907215","type":"CDM"},{"code":"636","type":"RC"},{"code":"90697","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.5,"setting":"both","billing_class":"facility"},{"gross_charge":144.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF HAND BIL-MMA","code_information":[{"code":"2907216","type":"CDM"},{"code":"510","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REHAB OR CASE MANAGER VISIT","code_information":[{"code":"2907217","type":"CDM"},{"code":"519","type":"RC"},{"code":"RN001","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.25,"setting":"both","billing_class":"professional"}]},{"description":"TEZSPIRE","drug_information":{"unit":"1.91","type":"ML"},"code_information":[{"code":"2907218","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":21844.8,"setting":"both","billing_class":"facility"}]},{"description":"TEZSPIRE 210MG VIAL INJ-MMA","code_information":[{"code":"2907218","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"}],"standard_charges":[{"gross_charge":4905.0,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":4905.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"TIXAGEV CILGAV 300MG ADM-MMA","code_information":[{"code":"2907219","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"BEBTELOVIMAB INJECTION-MMA","code_information":[{"code":"2907220","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"facility"},{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"MENQUADFI INJ-MMA","code_information":[{"code":"2907221","type":"CDM"},{"code":"636","type":"RC"},{"code":"90619","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"setting":"both","billing_class":"facility"},{"gross_charge":172.0,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT OF MOUTH LESION-MMA","code_information":[{"code":"2907222","type":"CDM"},{"code":"510","type":"RC"},{"code":"40820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3587.75,"setting":"both","billing_class":"professional"}]},{"description":"BIMATOPROST IMP 1MCG INJ-MMA","code_information":[{"code":"2907223","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7351","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.25,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":2531.25,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"INJECTION TREATMENT OF EYE-MMA","code_information":[{"code":"2907224","type":"CDM"},{"code":"510","type":"RC"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2676.0,"setting":"both","billing_class":"professional"}]},{"description":"PNEUMA/VAC WK BOOT PRE OTS-MMA","code_information":[{"code":"2907225","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4361","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.75,"setting":"both","billing_class":"facility"},{"gross_charge":334.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF TOE TENDON-MMA","code_information":[{"code":"2907226","type":"CDM"},{"code":"361","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":2125.5,"setting":"both","billing_class":"professional"}]},{"description":"KENALOG 10MG INJ-MMA","code_information":[{"code":"2907235","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":12.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"COVID 19 AMPLIFIED PROBE-MMA","code_information":[{"code":"2907236","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.25,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":135.25,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"PRQ IMPLTJ NEUROSTIMULATOR-MMA","code_information":[{"code":"2907237","type":"CDM"},{"code":"510","type":"RC"},{"code":"64555","type":"HCPCS"}],"standard_charges":[{"gross_charge":10960.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE  FACE MC BIL-MMA","code_information":[{"code":"2907239","type":"CDM"},{"code":"510","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 4 OR MORE BIL-MMA","code_information":[{"code":"2907240","type":"CDM"},{"code":"510","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXHALED NITRIC OXIDE MEAS-MMA","code_information":[{"code":"2907241","type":"CDM"},{"code":"510","type":"RC"},{"code":"95012","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"DETECT AGNT MULT DNA AMPLI-MMA","code_information":[{"code":"2907255","type":"CDM"},{"code":"306","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.25,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":297.25,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"CORRECTION OF ASTIGMATISM-MMA","code_information":[{"code":"2907256","type":"CDM"},{"code":"510","type":"RC"},{"code":"65772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1481.25,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ NEUROLYTIC AGENT NRV-MMA","code_information":[{"code":"2907257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2130.75,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 14 DAY DIS-MMA","code_information":[{"code":"2907258","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.75,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 7 DAY DIS-MMA","code_information":[{"code":"2907259","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.25,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND PELVIS LIMITED-MMA","code_information":[{"code":"2907261","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.5,"setting":"both","billing_class":"facility"},{"gross_charge":177.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"APPLY RIGID LEG CAST-MMA","code_information":[{"code":"2907262","type":"CDM"},{"code":"510","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.75,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS W/IMAGING-MMA","code_information":[{"code":"2907263","type":"CDM"},{"code":"510","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.75,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS WO/IMAGING-MMA","code_information":[{"code":"2907264","type":"CDM"},{"code":"510","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"setting":"both","billing_class":"professional"}]},{"description":"SALINE INF SONOHYSTERGRM-MMA","code_information":[{"code":"2907265","type":"CDM"},{"code":"402","type":"RC"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.5,"setting":"both","billing_class":"facility"},{"gross_charge":224.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"INSRT DRUG DEVICE-MMA","code_information":[{"code":"2907272","type":"CDM"},{"code":"510","type":"RC"},{"code":"68841","type":"HCPCS"}],"standard_charges":[{"gross_charge":2369.5,"setting":"both","billing_class":"professional"}]},{"description":"WC PADDING BANDAGE 3-5 IN-MMA","code_information":[{"code":"2907274","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6441","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"facility"},{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL SUTURE OR STAPLE-MMA","code_information":[{"code":"2907275","type":"CDM"},{"code":"510","type":"RC"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"setting":"both","billing_class":"professional","additional_generic_notes":"Gross Charge Type: Urgent Care"}]},{"description":"REMOVAL SUTURE AND STAPLE-MMA","code_information":[{"code":"2907276","type":"CDM"},{"code":"510","type":"RC"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM ANKLE LT-MMA","code_information":[{"code":"2907277","type":"CDM"},{"code":"510","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM ANKLE RT-MMA","code_information":[{"code":"2907278","type":"CDM"},{"code":"510","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"IMPLANT DEVICE C1889-MMA","code_information":[{"code":"2907279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8874.0,"setting":"both","billing_class":"facility"},{"gross_charge":8874.0,"setting":"both","billing_class":"professional"}]},{"description":"ADMN SARSCOV2 VACC 1 DOSE","code_information":[{"code":"2907300","type":"CDM"},{"code":"771","type":"RC"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.75,"setting":"both","billing_class":"facility"},{"gross_charge":44.75,"setting":"both","billing_class":"professional"}]},{"description":"SARSCOV2 VAC 3mcg TRS-SUC IM","code_information":[{"code":"2907301","type":"CDM"},{"code":"636","type":"RC"},{"code":"91318","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.5,"setting":"both","billing_class":"professional"}]},{"description":"SARSCOV2 VAC 10mcg TRS-SUC IM","code_information":[{"code":"2907302","type":"CDM"},{"code":"636","type":"RC"},{"code":"91319","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.25,"setting":"both","billing_class":"facility"},{"gross_charge":98.25,"setting":"both","billing_class":"professional"}]},{"description":"SARSCOV2 VAC 30mcg TRS-SUC IM","code_information":[{"code":"2907303","type":"CDM"},{"code":"636","type":"RC"},{"code":"91320","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility"},{"gross_charge":146.75,"setting":"both","billing_class":"professional"}]},{"description":"BEYFORTUS","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2907304","type":"CDM"},{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281057500","type":"NDC"}],"standard_charges":[{"gross_charge":5717.25,"setting":"both","billing_class":"facility"}]},{"description":"RSV MONOC ANTB 0.5ML IM-MMA","code_information":[{"code":"2907304","type":"CDM"},{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"setting":"both","billing_class":"facility"},{"gross_charge":532.0,"setting":"both","billing_class":"professional"}]},{"description":"BEYFORTUS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2907305","type":"CDM"},{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281057488","type":"NDC"}],"standard_charges":[{"gross_charge":5717.25,"setting":"both","billing_class":"facility"}]},{"description":"RSV MONOC ANTB SESN 1ML IM-MMA","code_information":[{"code":"2907305","type":"CDM"},{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"setting":"both","billing_class":"facility"},{"gross_charge":532.0,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN RSV MONOC ANTB W/CNSL","code_information":[{"code":"2907306","type":"CDM"},{"code":"771","type":"RC"},{"code":"96380","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.75,"setting":"both","billing_class":"facility"},{"gross_charge":23.75,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN RSV MONOC ANTB IM NJX","code_information":[{"code":"2907307","type":"CDM"},{"code":"771","type":"RC"},{"code":"96381","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"facility"},{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"PENBRAYA MENIGCCAL VACCINE","code_information":[{"code":"2907308","type":"CDM"},{"code":"636","type":"RC"},{"code":"90623","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.5,"setting":"both","billing_class":"facility"},{"gross_charge":294.5,"setting":"both","billing_class":"professional"}]},{"description":"PENICILLIN G POTASSIUM-MMA","code_information":[{"code":"2907400","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":37.75,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"VENTOLIN HFA 108MCG/ACT-MMA","code_information":[{"code":"2907401","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3535","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":27.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"LEVLBUTEROL TART 45MCG/ACT-MMA","code_information":[{"code":"2907402","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3535","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":62.0,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"AMOXICILLIN 250MG/5ML ORAL-MMA","code_information":[{"code":"2907403","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP ALLERGY IMMU ADMIN-MMA","code_information":[{"code":"2908000","type":"CDM"},{"code":"990","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.25,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY PPSV23 VACC-MMA","code_information":[{"code":"2908001","type":"CDM"},{"code":"990","type":"RC"},{"code":"90732","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.5,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY SKIN TSTS-MMA","code_information":[{"code":"2908002","type":"CDM"},{"code":"990","type":"RC"},{"code":"95004","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.5,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY PERQ&IC TST DRG-MMA","code_information":[{"code":"2908003","type":"CDM"},{"code":"990","type":"RC"},{"code":"95018","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY ID TST DRG/BUG-MMA","code_information":[{"code":"2908004","type":"CDM"},{"code":"990","type":"RC"},{"code":"95024","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY INGEST 120MIN-MMA","code_information":[{"code":"2908005","type":"CDM"},{"code":"990","type":"RC"},{"code":"95076","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.75,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY INGST ADL 60MIN-MMA","code_information":[{"code":"2908006","type":"CDM"},{"code":"990","type":"RC"},{"code":"95079","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY IMUNOTHRPY 1INJ-MMA","code_information":[{"code":"2908007","type":"CDM"},{"code":"990","type":"RC"},{"code":"95115","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.25,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY IMNOTHRPY INJCT-MMA","code_information":[{"code":"2908008","type":"CDM"},{"code":"990","type":"RC"},{"code":"95117","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY PREP IMUN;SGL/M-MMA","code_information":[{"code":"2908009","type":"CDM"},{"code":"990","type":"RC"},{"code":"95165","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.25,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY THER/PROPH/DIAG-MMA","code_information":[{"code":"2908010","type":"CDM"},{"code":"990","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.25,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY OFC LEV 3 NEW-MMA","code_information":[{"code":"2908011","type":"CDM"},{"code":"990","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.5,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY OFC LEV 4 NEW-MMA","code_information":[{"code":"2908012","type":"CDM"},{"code":"990","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY OFC LEV 3 EST-MMA","code_information":[{"code":"2908013","type":"CDM"},{"code":"990","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.75,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY OFC LEV 4 EST-MMA","code_information":[{"code":"2908014","type":"CDM"},{"code":"990","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.25,"setting":"both","billing_class":"professional"}]},{"description":"SP ALLERGY XOLAIR 150MG/ML-MMA","code_information":[{"code":"2908016","type":"CDM"},{"code":"990","type":"RC"},{"code":"J2357","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP ALLERGY MTHLPRDNS 125MG-MMA","code_information":[{"code":"2908017","type":"CDM"},{"code":"990","type":"RC"},{"code":"J2919","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP GENETIC/PREV COUNSEL 45MIN","code_information":[{"code":"2908018","type":"CDM"},{"code":"990","type":"RC"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"setting":"both","billing_class":"professional"}]},{"description":"SP GENETIC/PREV COUNSEL 1 HOUR","code_information":[{"code":"2908019","type":"CDM"},{"code":"990","type":"RC"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ACUPUNCTURE INITIAL 45MIN","code_information":[{"code":"2908020","type":"CDM"},{"code":"940","type":"RC"},{"code":"97810","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"setting":"both","billing_class":"professional"}]},{"description":"SP ACUPUNTURE F/U VISIT 45MIN","code_information":[{"code":"2908021","type":"CDM"},{"code":"940","type":"RC"},{"code":"97811","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.25,"setting":"both","billing_class":"professional"}]},{"description":"SP VFC VACCINE ADMIN-MMA","code_information":[{"code":"2908022","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.79,"setting":"both","billing_class":"facility"},{"gross_charge":28.79,"setting":"both","billing_class":"professional"}]},{"description":"SP XEOMIN 20 UNIT INJ-MMA","code_information":[{"code":"2908023","type":"CDM"},{"code":"990","type":"RC"},{"code":"J0588","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP XEOMIN 1UN EACH ADD INJ-MMA","code_information":[{"code":"2908024","type":"CDM"},{"code":"990","type":"RC"},{"code":"J0588","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP XEOMIN 100 UNIT INJ-MMA","code_information":[{"code":"2908025","type":"CDM"},{"code":"990","type":"RC"},{"code":"J0588","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP BOTOX 100 UNIT INJ-MMA","code_information":[{"code":"2908026","type":"CDM"},{"code":"990","type":"RC"},{"code":"J0585","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP SINGLE EYE ORA-MMA","code_information":[{"code":"2908027","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":375.0,"setting":"both","billing_class":"professional"}]},{"description":"SP KISUNLA 700MG VIAL-MMA","code_information":[{"code":"2908028","type":"CDM"},{"code":"990","type":"RC"},{"code":"J0175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":2100.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"SP INJ PLATELET PLASMA-MMA","code_information":[{"code":"2908500","type":"CDM"},{"code":"990","type":"RC"},{"code":"0232T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"setting":"both","billing_class":"professional"}]},{"description":"NO SHOW FEE FOR DOC APPT-MMA","code_information":[{"code":"2908510","type":"CDM"},{"code":"969","type":"RC"}],"standard_charges":[{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"NO SHOW FEE OFFICE PROC-MMA","code_information":[{"code":"2908511","type":"CDM"},{"code":"969","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"setting":"both","billing_class":"professional"}]},{"description":"TELEHEALTH ORIGINAT SITE-FAC","code_information":[{"code":"2920001","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"facility"}]},{"description":"FNA W/O IMAGE-FAC","code_information":[{"code":"2920010","type":"CDM"},{"code":"361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE SKIN ABSCESS-FAC","code_information":[{"code":"2920014","type":"CDM"},{"code":"361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"setting":"both","billing_class":"facility"},{"gross_charge":337.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY;SIMPLE-FAC","code_information":[{"code":"2920015","type":"CDM"},{"code":"361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"ACNE SURGERY-FAC","code_information":[{"code":"2920016","type":"CDM"},{"code":"361","type":"RC"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"setting":"both","billing_class":"facility"},{"gross_charge":176.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PILONIDAL CYST;SIMPL-FAC","code_information":[{"code":"2920017","type":"CDM"},{"code":"361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.25,"setting":"both","billing_class":"facility"},{"gross_charge":620.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY;COMPLEX-FAC","code_information":[{"code":"2920018","type":"CDM"},{"code":"361","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.75,"setting":"both","billing_class":"facility"},{"gross_charge":1421.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SKIN ABSCESS-FAC","code_information":[{"code":"2920019","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PILONIDAL CYST;COMP-FAC","code_information":[{"code":"2920028","type":"CDM"},{"code":"361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.5,"setting":"both","billing_class":"facility"},{"gross_charge":1023.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE HEMATOMA-FAC","code_information":[{"code":"2920037","type":"CDM"},{"code":"361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.75,"setting":"both","billing_class":"facility"},{"gross_charge":1421.75,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE DRAINAGE LESION-FAC","code_information":[{"code":"2920040","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"setting":"both","billing_class":"facility"},{"gross_charge":337.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE INFECTED SKIN-FAC","code_information":[{"code":"2920043","type":"CDM"},{"code":"361","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.75,"setting":"both","billing_class":"facility"},{"gross_charge":507.75,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SKIN/TISSUE-FAC","code_information":[{"code":"2920046","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.5,"setting":"both","billing_class":"facility"},{"gross_charge":749.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE<20CM ADDL-FAC","code_information":[{"code":"2920055","type":"CDM"},{"code":"361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.75,"setting":"both","billing_class":"facility"},{"gross_charge":222.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESION-FAC","code_information":[{"code":"2920058","type":"CDM"},{"code":"361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESIONS 2TO4-FAC","code_information":[{"code":"2920061","type":"CDM"},{"code":"361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESION >4-FAC","code_information":[{"code":"2920064","type":"CDM"},{"code":"361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"REM SKIN TAGS-FAC","code_information":[{"code":"2920073","type":"CDM"},{"code":"361","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REM SKIN TAGS ADDL-FAC","code_information":[{"code":"2920076","type":"CDM"},{"code":"361","type":"RC"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920079","type":"CDM"},{"code":"361","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"setting":"both","billing_class":"facility"},{"gross_charge":389.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920082","type":"CDM"},{"code":"361","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.75,"setting":"both","billing_class":"facility"},{"gross_charge":175.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920085","type":"CDM"},{"code":"361","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.75,"setting":"both","billing_class":"facility"},{"gross_charge":175.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE LESION TR/A/L >2CM-FAC","code_information":[{"code":"2920088","type":"CDM"},{"code":"361","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"setting":"both","billing_class":"facility"},{"gross_charge":337.5,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920091","type":"CDM"},{"code":"361","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"setting":"both","billing_class":"facility"},{"gross_charge":176.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920094","type":"CDM"},{"code":"361","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.75,"setting":"both","billing_class":"facility"},{"gross_charge":175.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920097","type":"CDM"},{"code":"361","type":"RC"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":260.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920100","type":"CDM"},{"code":"361","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":260.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920103","type":"CDM"},{"code":"361","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":260.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-FAC","code_information":[{"code":"2920106","type":"CDM"},{"code":"361","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN 0.5<CM-FAC","code_information":[{"code":"2920109","type":"CDM"},{"code":"361","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN 0.6-1CM-FAC","code_information":[{"code":"2920112","type":"CDM"},{"code":"361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"setting":"both","billing_class":"facility"},{"gross_charge":555.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN 1.1-2CM-FAC","code_information":[{"code":"2920115","type":"CDM"},{"code":"361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.25,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN 2.1-3CM-FAC","code_information":[{"code":"2920118","type":"CDM"},{"code":"361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN 3.1-4CM-FAC","code_information":[{"code":"2920121","type":"CDM"},{"code":"361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT BENIGN >4CM-FAC","code_information":[{"code":"2920124","type":"CDM"},{"code":"361","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP B9MAR .5<-FAC","code_information":[{"code":"2920127","type":"CDM"},{"code":"361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP B9 0.6-1-FAC","code_information":[{"code":"2920130","type":"CDM"},{"code":"361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP B9MAR 1.1-2-FAC","code_information":[{"code":"2920133","type":"CDM"},{"code":"361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP BENIGN 2.1-3-FAC","code_information":[{"code":"2920136","type":"CDM"},{"code":"361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP BENIGN 3.1-4-FAC","code_information":[{"code":"2920139","type":"CDM"},{"code":"361","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM BENIGN .5<CM-FAC","code_information":[{"code":"2920142","type":"CDM"},{"code":"361","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"EX F M B9MAR .6-1CM-FAC","code_information":[{"code":"2920145","type":"CDM"},{"code":"361","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM BENIGN 1.1-2CM-FAC","code_information":[{"code":"2920148","type":"CDM"},{"code":"361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM BENIGN 2.1-3CM-FAC","code_information":[{"code":"2920151","type":"CDM"},{"code":"361","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM BENIGN 3.1-4CM-FAC","code_information":[{"code":"2920154","type":"CDM"},{"code":"361","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX MAL LESION TR/EXT-FAC","code_information":[{"code":"2920157","type":"CDM"},{"code":"361","type":"RC"},{"code":"11600","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.5,"setting":"both","billing_class":"facility"},{"gross_charge":758.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT MALIGN .6-1CM-FAC","code_information":[{"code":"2920160","type":"CDM"},{"code":"361","type":"RC"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.5,"setting":"both","billing_class":"facility"},{"gross_charge":758.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT MALIGN 1.1-2CM-FAC","code_information":[{"code":"2920163","type":"CDM"},{"code":"361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"setting":"both","billing_class":"facility"},{"gross_charge":555.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EXT MALIGNANT LES-FAC","code_information":[{"code":"2920166","type":"CDM"},{"code":"361","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR EXT MALIGN 3.1-4CM-FAC","code_information":[{"code":"2920169","type":"CDM"},{"code":"361","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX MALGN LES TR/EXT>4CM-FAC","code_information":[{"code":"2920172","type":"CDM"},{"code":"361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC H/F/NK/SP MAL .5<-FAC","code_information":[{"code":"2920174","type":"CDM"},{"code":"361","type":"RC"},{"code":"11620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EX MAL LES S/N/H/F/G-FAC","code_information":[{"code":"2920175","type":"CDM"},{"code":"361","type":"RC"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/NK/SP MALIGN 1.1-2-FAC","code_information":[{"code":"2920178","type":"CDM"},{"code":"361","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC S/N/H/F/G MLG 2.1-3-FAC","code_information":[{"code":"2920179","type":"CDM"},{"code":"361","type":"RC"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC S/N/H/F/G MAL 3.1-4-FAC","code_information":[{"code":"2920180","type":"CDM"},{"code":"361","type":"RC"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H F NK SP MALIGN >4CM-FAC","code_information":[{"code":"2920181","type":"CDM"},{"code":"361","type":"RC"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.75,"setting":"both","billing_class":"facility"},{"gross_charge":3084.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM MALIGN .6-1CM-FAC","code_information":[{"code":"2920184","type":"CDM"},{"code":"361","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.25,"setting":"both","billing_class":"facility"},{"gross_charge":977.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM MALIGN 1.1-2CM-FAC","code_information":[{"code":"2920187","type":"CDM"},{"code":"361","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.25,"setting":"both","billing_class":"facility"},{"gross_charge":977.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM MALIG 2.1-3CM-FAC","code_information":[{"code":"2920190","type":"CDM"},{"code":"361","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EX MALIG LES F/E/E/N/L-FAC","code_information":[{"code":"2920193","type":"CDM"},{"code":"361","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.25,"setting":"both","billing_class":"facility"},{"gross_charge":1746.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE MM MALIGN >4CM-FAC","code_information":[{"code":"2920196","type":"CDM"},{"code":"361","type":"RC"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.75,"setting":"both","billing_class":"facility"},{"gross_charge":3084.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIM NONDYSTROPHIC NAILS-FAC","code_information":[{"code":"2920199","type":"CDM"},{"code":"361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDEMENT NAIL 1-5-FAC","code_information":[{"code":"2920202","type":"CDM"},{"code":"361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE NAIL 6 OR MORE-FAC","code_information":[{"code":"2920205","type":"CDM"},{"code":"361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"REM NAIL PLATE-FAC","code_information":[{"code":"2920208","type":"CDM"},{"code":"361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"AVULSION OF NAIL EA ADDL-FAC","code_information":[{"code":"2920211","type":"CDM"},{"code":"361","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.25,"setting":"both","billing_class":"facility"},{"gross_charge":21.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN BLOOD FROM NAIL-FAC","code_information":[{"code":"2920214","type":"CDM"},{"code":"361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"REM NAIL BED-FAC","code_information":[{"code":"2920217","type":"CDM"},{"code":"361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"setting":"both","billing_class":"facility"},{"gross_charge":448.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TOE NAIL FOLD-FAC","code_information":[{"code":"2920220","type":"CDM"},{"code":"361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ INTO SKIN LESIONS-FAC","code_information":[{"code":"2920223","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REM CONTRACEPTIVE CAP-FAC","code_information":[{"code":"2920226","type":"CDM"},{"code":"361","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT DRUG IMPLANT DEV-FAC","code_information":[{"code":"2920229","type":"CDM"},{"code":"361","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"REM DRUG IMPLANT DEV-FAC","code_information":[{"code":"2920232","type":"CDM"},{"code":"361","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.5,"setting":"both","billing_class":"facility"},{"gross_charge":396.5,"setting":"both","billing_class":"professional"}]},{"description":"REM/INSERT DRUG IMPLANT-FAC","code_information":[{"code":"2920235","type":"CDM"},{"code":"361","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.5,"setting":"both","billing_class":"facility"},{"gross_charge":396.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR WOUND SUPERFICIAL-FAC","code_information":[{"code":"2920238","type":"CDM"},{"code":"361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.5,"setting":"both","billing_class":"facility"},{"gross_charge":211.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-FAC","code_information":[{"code":"2920241","type":"CDM"},{"code":"361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"facility"},{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR WOUND SUPERFICIAL-FAC","code_information":[{"code":"2920244","type":"CDM"},{"code":"361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR WOUND SUPERFICIAL-FAC","code_information":[{"code":"2920247","type":"CDM"},{"code":"361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR WOUND SUPERFICIAL-FAC","code_information":[{"code":"2920250","type":"CDM"},{"code":"361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.5,"setting":"both","billing_class":"facility"},{"gross_charge":606.5,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE OF SPLIT WOUND-FAC","code_information":[{"code":"2920253","type":"CDM"},{"code":"361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.5,"setting":"both","billing_class":"facility"},{"gross_charge":548.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.5CM/<-FAC","code_information":[{"code":"2920259","type":"CDM"},{"code":"361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-FAC","code_information":[{"code":"2920262","type":"CDM"},{"code":"361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 7.6-12.5CM-FAC","code_information":[{"code":"2920265","type":"CDM"},{"code":"361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-FAC","code_information":[{"code":"2920268","type":"CDM"},{"code":"361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND FACE 2.5CM/<-FAC","code_information":[{"code":"2920271","type":"CDM"},{"code":"361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND FACE 2.6-5CM-FAC","code_information":[{"code":"2920274","type":"CDM"},{"code":"361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR TRNK/ARM/LEG-FAC","code_information":[{"code":"2920277","type":"CDM"},{"code":"361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.5,"setting":"both","billing_class":"facility"},{"gross_charge":1875.5,"setting":"both","billing_class":"professional"}]},{"description":"SK GR T/AR/L<100C add25sq-FAC","code_information":[{"code":"2920280","type":"CDM"},{"code":"361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility"},{"gross_charge":96.25,"setting":"both","billing_class":"professional"}]},{"description":"SK GR FC/NC/HAN/F 1st25CM-FAC","code_information":[{"code":"2920283","type":"CDM"},{"code":"361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.5,"setting":"both","billing_class":"facility"},{"gross_charge":1875.5,"setting":"both","billing_class":"professional"}]},{"description":"SK GR F/N/H/F<100Cadd25sq-FAC","code_information":[{"code":"2920286","type":"CDM"},{"code":"361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility"},{"gross_charge":96.25,"setting":"both","billing_class":"professional"}]},{"description":"TX OF BURN INITIAL-FAC","code_information":[{"code":"2920289","type":"CDM"},{"code":"361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DRESS/DEBRID P-THICK BURN-FAC","code_information":[{"code":"2920292","type":"CDM"},{"code":"361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE/DRESS BURN-FAC","code_information":[{"code":"2920295","type":"CDM"},{"code":"361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DRESS/DEBRID P THICK BURN-FAC","code_information":[{"code":"2920298","type":"CDM"},{"code":"361","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY BEGIGN/PREMIG LES-FAC","code_information":[{"code":"2920302","type":"CDM"},{"code":"361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY LESIONS 2-14-FAC","code_information":[{"code":"2920305","type":"CDM"},{"code":"361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.25,"setting":"both","billing_class":"facility"},{"gross_charge":30.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY PREMAL LES 15&>-FAC","code_information":[{"code":"2920308","type":"CDM"},{"code":"361","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.75,"setting":"both","billing_class":"facility"},{"gross_charge":430.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VASC LES<10SQ CM-FAC","code_information":[{"code":"2920311","type":"CDM"},{"code":"361","type":"RC"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"setting":"both","billing_class":"facility"},{"gross_charge":494.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LESION  1-14-FAC","code_information":[{"code":"2920314","type":"CDM"},{"code":"361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LESION 15&>-FAC","code_information":[{"code":"2920317","type":"CDM"},{"code":"361","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL CAUTERY TISSUE-FAC","code_information":[{"code":"2920320","type":"CDM"},{"code":"361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY MALIG LES T/A/L-FAC","code_information":[{"code":"2920323","type":"CDM"},{"code":"361","type":"RC"},{"code":"17262","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY MALG LES .6-1CM-FAC","code_information":[{"code":"2920326","type":"CDM"},{"code":"361","type":"RC"},{"code":"17281","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"CRYOTHERAPY OF SKIN-FAC","code_information":[{"code":"2920329","type":"CDM"},{"code":"361","type":"RC"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF BREAST LESION-FAC","code_information":[{"code":"2920332","type":"CDM"},{"code":"361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST 1ST LESION US-FAC","code_information":[{"code":"2920335","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"BX BRST PERCUT W/O IMAGE-FAC","code_information":[{"code":"2920338","type":"CDM"},{"code":"361","type":"RC"},{"code":"19100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST OPEN-FAC","code_information":[{"code":"2920341","type":"CDM"},{"code":"361","type":"RC"},{"code":"19101","type":"HCPCS"}],"standard_charges":[{"gross_charge":3198.25,"setting":"both","billing_class":"facility"},{"gross_charge":3198.25,"setting":"both","billing_class":"professional"}]},{"description":"REM BREAST LESION-FAC","code_information":[{"code":"2920344","type":"CDM"},{"code":"361","type":"RC"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3198.25,"setting":"both","billing_class":"facility"},{"gross_charge":3198.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY COMPRS LWR LEG BIL-FAC","code_information":[{"code":"2920501","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":243.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED ALL/IMMLG SVC/PX-FAC","code_information":[{"code":"2920503","type":"CDM"},{"code":"924","type":"RC"},{"code":"95199","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"setting":"both","billing_class":"facility"},{"gross_charge":31.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR NSL VLV CLPSE W/RMDL-FAC","code_information":[{"code":"2920504","type":"CDM"},{"code":"361","type":"RC"},{"code":"30469","type":"HCPCS"}],"standard_charges":[{"gross_charge":6022.25,"setting":"both","billing_class":"facility"},{"gross_charge":6022.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER 2 VW LT-FAC/TEC","code_information":[{"code":"2920505","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":113.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY ELBOW 3 VIEW LT-FAC/TEC","code_information":[{"code":"2920506","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY WRIST 3 VIEW LT-FAC/TEC","code_information":[{"code":"2920507","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HAND 3 VIEW LT-FAC/TEC","code_information":[{"code":"2920508","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HIP 2-3 VIEW LT-FAC/TEC","code_information":[{"code":"2920509","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NEUROMUSCULAR JUNCTION TST-FAC","code_information":[{"code":"2920510","type":"CDM"},{"code":"922","type":"RC"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.75,"setting":"both","billing_class":"facility"},{"gross_charge":160.75,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED NERVOUS SYSTEM PX-FAC","code_information":[{"code":"2920511","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.25,"setting":"both","billing_class":"facility"},{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC NEUROFIBROM CUT NRV-FAC","code_information":[{"code":"2920513","type":"CDM"},{"code":"361","type":"RC"},{"code":"64788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1981.0,"setting":"both","billing_class":"facility"},{"gross_charge":1981.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC TUMOR ABD LES SC 3CM/>-FAC","code_information":[{"code":"2920514","type":"CDM"},{"code":"361","type":"RC"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":2846.75,"setting":"both","billing_class":"facility"},{"gross_charge":2846.75,"setting":"both","billing_class":"professional"}]},{"description":"SPINE SINGLE VIEW-FAC","code_information":[{"code":"2920515","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility"},{"gross_charge":96.25,"setting":"both","billing_class":"professional"}]},{"description":"OB US DETAILED SNGL FETUS-FAC","code_information":[{"code":"2920516","type":"CDM"},{"code":"402","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"setting":"both","billing_class":"facility"},{"gross_charge":257.5,"setting":"both","billing_class":"professional"}]},{"description":"OB US BIOPH PROF W/NST-FAC","code_information":[{"code":"2920517","type":"CDM"},{"code":"402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"setting":"both","billing_class":"facility"},{"gross_charge":118.0,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/STIM 15MIN-FAC","code_information":[{"code":"2920518","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97813","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"setting":"both","billing_class":"facility"},{"gross_charge":28.0,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JNT/BRSA WO US BIL-FAC","code_information":[{"code":"2920521","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":450.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTOSCOPY REMOVAL/CLOTS-FAC","code_information":[{"code":"2920522","type":"CDM"},{"code":"361","type":"RC"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.0,"setting":"both","billing_class":"facility"},{"gross_charge":3532.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF FORGEIN BODY-FAC","code_information":[{"code":"2920523","type":"CDM"},{"code":"361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.5,"setting":"both","billing_class":"facility"},{"gross_charge":1669.5,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPCT WAX W/TOOL BIL-FAC","code_information":[{"code":"2920524","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":95.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EX ARM/ELBW TUM DEEP 5CM/>-FAC","code_information":[{"code":"2920525","type":"CDM"},{"code":"361","type":"RC"},{"code":"24073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EX ARM/ELBOW TUM DEEP <5CM-FAC","code_information":[{"code":"2920526","type":"CDM"},{"code":"361","type":"RC"},{"code":"24076","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOREARM TUM DEEP 3CM/>-FAC","code_information":[{"code":"2920527","type":"CDM"},{"code":"361","type":"RC"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOREARM TUM DEEP <3CM-FAC","code_information":[{"code":"2920528","type":"CDM"},{"code":"361","type":"RC"},{"code":"25076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.5,"setting":"both","billing_class":"facility"},{"gross_charge":1669.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV TUM DEEP 5CM/>FAC","code_information":[{"code":"2920529","type":"CDM"},{"code":"361","type":"RC"},{"code":"27045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV LES SC < 3CM-FAC","code_information":[{"code":"2920530","type":"CDM"},{"code":"361","type":"RC"},{"code":"27047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV TUM DEEP <5CM-FAC","code_information":[{"code":"2920531","type":"CDM"},{"code":"361","type":"RC"},{"code":"27048","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC THGH/KNEE TUM DEP <5CM-FAC","code_information":[{"code":"2920532","type":"CDM"},{"code":"361","type":"RC"},{"code":"27328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC THGH/KNEE TUM DEP 5CM/>FAC","code_information":[{"code":"2920533","type":"CDM"},{"code":"361","type":"RC"},{"code":"27339","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM < 3CM-FAC","code_information":[{"code":"2920534","type":"CDM"},{"code":"361","type":"RC"},{"code":"27618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.5,"setting":"both","billing_class":"facility"},{"gross_charge":1669.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM DEP <5CM-FAC","code_information":[{"code":"2920535","type":"CDM"},{"code":"361","type":"RC"},{"code":"27619","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE LES SC 3CM/>-FAC","code_information":[{"code":"2920536","type":"CDM"},{"code":"361","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM DEP 5CM/>FAC","code_information":[{"code":"2920537","type":"CDM"},{"code":"361","type":"RC"},{"code":"27634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM SC 1.5CM/>FAC","code_information":[{"code":"2920538","type":"CDM"},{"code":"361","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FT/TOE TUM DEP 1.5CM/>FAC","code_information":[{"code":"2920539","type":"CDM"},{"code":"361","type":"RC"},{"code":"28041","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM SC <1.5CM-FAC","code_information":[{"code":"2920540","type":"CDM"},{"code":"361","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.5,"setting":"both","billing_class":"facility"},{"gross_charge":1669.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM DEP<1.5CM-FAC","code_information":[{"code":"2920541","type":"CDM"},{"code":"361","type":"RC"},{"code":"28045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FACE TUM DEEP 2 CM/>-FAC","code_information":[{"code":"2920542","type":"CDM"},{"code":"361","type":"RC"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC NECK TUM DEEP 5CM/>-FAC","code_information":[{"code":"2920543","type":"CDM"},{"code":"361","type":"RC"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC NECK TUM DEEP < 5CM-FAC","code_information":[{"code":"2920544","type":"CDM"},{"code":"361","type":"RC"},{"code":"21556","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC BACK TUM DEEP 5CM/>-FAC","code_information":[{"code":"2920545","type":"CDM"},{"code":"361","type":"RC"},{"code":"21933","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP < 5CM-FAC","code_information":[{"code":"2920546","type":"CDM"},{"code":"361","type":"RC"},{"code":"22900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP 5CM/>-FAC","code_information":[{"code":"2920547","type":"CDM"},{"code":"361","type":"RC"},{"code":"22901","type":"HCPCS"}],"standard_charges":[{"gross_charge":2925.25,"setting":"both","billing_class":"facility"},{"gross_charge":2925.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABD LES SC < 3CM-FAC","code_information":[{"code":"2920548","type":"CDM"},{"code":"361","type":"RC"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.5,"setting":"both","billing_class":"facility"},{"gross_charge":1669.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE LUNG CATHETER-FAC","code_information":[{"code":"2920549","type":"CDM"},{"code":"361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.25,"setting":"both","billing_class":"facility"},{"gross_charge":647.25,"setting":"both","billing_class":"professional"}]},{"description":"EXCISION OF PENIS LESION-FAC","code_information":[{"code":"2920550","type":"CDM"},{"code":"361","type":"RC"},{"code":"54060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"setting":"both","billing_class":"facility"},{"gross_charge":1902.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF MISCARRIAGE-FAC","code_information":[{"code":"2920551","type":"CDM"},{"code":"361","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"setting":"both","billing_class":"facility"},{"gross_charge":3215.0,"setting":"both","billing_class":"professional"}]},{"description":"CLN OUT MASTOID CAVITY BIL-FAC","code_information":[{"code":"2920552","type":"CDM"},{"code":"361","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":309.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"RECONSTRUCT EXTRA FINGER-FAC","code_information":[{"code":"2920554","type":"CDM"},{"code":"361","type":"RC"},{"code":"26587","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.75,"setting":"both","billing_class":"facility"},{"gross_charge":3328.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL PEEL NONFACIAL-FAC","code_information":[{"code":"2920555","type":"CDM"},{"code":"361","type":"RC"},{"code":"15792","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.25,"setting":"both","billing_class":"facility"},{"gross_charge":646.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLCK INJ PLNTR DIGIT BIL-FAC","code_information":[{"code":"2920556","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CHEMICAL PEEL FACE EPIDERM-FAC","code_information":[{"code":"2920557","type":"CDM"},{"code":"361","type":"RC"},{"code":"15788","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.5,"setting":"both","billing_class":"facility"},{"gross_charge":410.5,"setting":"both","billing_class":"professional"}]},{"description":"FILLETED FINGER/TOE FLAP-FAC","code_information":[{"code":"2920558","type":"CDM"},{"code":"361","type":"RC"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.5,"setting":"both","billing_class":"facility"},{"gross_charge":1875.5,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT OF ANKLE FX-FAC","code_information":[{"code":"2920560","type":"CDM"},{"code":"361","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.25,"setting":"both","billing_class":"facility"},{"gross_charge":1581.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LWR SPINE BENDING-FAC/TEC","code_information":[{"code":"2920561","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"setting":"both","billing_class":"facility"},{"gross_charge":118.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY THORACIC SPINE 3V-FAC/TEC","code_information":[{"code":"2920562","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"setting":"both","billing_class":"facility"},{"gross_charge":118.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"PREV MED CNSL INDIV 30M-FAC","code_information":[{"code":"2920564","type":"CDM"},{"code":"942","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"THER INJ CARP TUNNEL-FAC","code_information":[{"code":"2920600","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.5,"setting":"both","billing_class":"facility"},{"gross_charge":300.5,"setting":"both","billing_class":"professional"}]},{"description":"INJECTION TENDON SHEATH-FAC","code_information":[{"code":"2920603","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON ORIGIN/INSERT-FAC","code_information":[{"code":"2920606","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"TRIGGER PNT INJ 1-2 MUSC-FAC","code_information":[{"code":"2920609","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER POINT >3MUSC-FAC","code_information":[{"code":"2920612","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JOINT/BURSA-FAC","code_information":[{"code":"2920615","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ JOINT/BURSA-FAC","code_information":[{"code":"2920618","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JOINT/BURSA-FAC","code_information":[{"code":"2920621","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"facility"},{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ MAJOR JNT/BURS-FAC","code_information":[{"code":"2920624","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"facility"},{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"ASP/INJ GANGLION CYST-FAC","code_information":[{"code":"2920627","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF IMPLANT SUPERFICIAL-FAC","code_information":[{"code":"2920630","type":"CDM"},{"code":"361","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1667.5,"setting":"both","billing_class":"facility"},{"gross_charge":1667.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR SOFT TI F/SC>2CM-FAC","code_information":[{"code":"2920633","type":"CDM"},{"code":"361","type":"RC"},{"code":"21012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.75,"setting":"both","billing_class":"facility"},{"gross_charge":1629.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE TUM DEEP<2CM-FAC","code_information":[{"code":"2920636","type":"CDM"},{"code":"361","type":"RC"},{"code":"21013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"I&D ABSC SFT TIS N/TH-FAC","code_information":[{"code":"2920642","type":"CDM"},{"code":"361","type":"RC"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"REM LES NECK/CHE >3CM-FAC","code_information":[{"code":"2920645","type":"CDM"},{"code":"361","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"REM LES NECK/CHEST<3CM-FAC","code_information":[{"code":"2920648","type":"CDM"},{"code":"361","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT STERNUM FX-FAC","code_information":[{"code":"2920651","type":"CDM"},{"code":"361","type":"RC"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"REM LESION BACK<3CM-FAC","code_information":[{"code":"2920654","type":"CDM"},{"code":"361","type":"RC"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.5,"setting":"both","billing_class":"facility"},{"gross_charge":1584.5,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK LESION 3CM/>-FAC","code_information":[{"code":"2920657","type":"CDM"},{"code":"361","type":"RC"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUMOR DEEP-FAC","code_information":[{"code":"2920660","type":"CDM"},{"code":"361","type":"RC"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SPINE FX-FAC","code_information":[{"code":"2920663","type":"CDM"},{"code":"361","type":"RC"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"REM LESION SHOULDER>3CM-FAC","code_information":[{"code":"2920666","type":"CDM"},{"code":"361","type":"RC"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2153.75,"setting":"both","billing_class":"facility"},{"gross_charge":2153.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT CLAVICLE FX-FAC","code_information":[{"code":"2920669","type":"CDM"},{"code":"361","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TX ACROMIOCLAV DISLOC-FAC","code_information":[{"code":"2920672","type":"CDM"},{"code":"361","type":"RC"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SHOULDER BLADE FX-FAC","code_information":[{"code":"2920675","type":"CDM"},{"code":"361","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920678","type":"CDM"},{"code":"361","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920681","type":"CDM"},{"code":"361","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SHLDR DISLOCATION-FAC","code_information":[{"code":"2920684","type":"CDM"},{"code":"361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISE ARM/ELBOW LESION-FAC","code_information":[{"code":"2920687","type":"CDM"},{"code":"361","type":"RC"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920690","type":"CDM"},{"code":"361","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920693","type":"CDM"},{"code":"361","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920696","type":"CDM"},{"code":"361","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-FAC","code_information":[{"code":"2920699","type":"CDM"},{"code":"361","type":"RC"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIAL HEAD FX-FAC","code_information":[{"code":"2920702","type":"CDM"},{"code":"361","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.75,"setting":"both","billing_class":"facility"},{"gross_charge":280.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS FX-FAC","code_information":[{"code":"2920705","type":"CDM"},{"code":"361","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ULNAR FX-FAC","code_information":[{"code":"2920708","type":"CDM"},{"code":"361","type":"RC"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION FOREARM-FAC","code_information":[{"code":"2920711","type":"CDM"},{"code":"361","type":"RC"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FOREARM/WR SUBC <3CM-FAC","code_information":[{"code":"2920714","type":"CDM"},{"code":"361","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.25,"setting":"both","billing_class":"facility"},{"gross_charge":1577.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF RADIUS-FAC","code_information":[{"code":"2920717","type":"CDM"},{"code":"361","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ULNAR FX-FAC","code_information":[{"code":"2920720","type":"CDM"},{"code":"361","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS & ULNAR FX-FAC","code_information":[{"code":"2920723","type":"CDM"},{"code":"361","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS & ULNAR FX-FAC","code_information":[{"code":"2920726","type":"CDM"},{"code":"361","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS & ULNAR FX-FAC","code_information":[{"code":"2920729","type":"CDM"},{"code":"361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS & ULNAR FX-FAC","code_information":[{"code":"2920732","type":"CDM"},{"code":"361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-FAC","code_information":[{"code":"2920735","type":"CDM"},{"code":"361","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-FAC","code_information":[{"code":"2920738","type":"CDM"},{"code":"361","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-FAC","code_information":[{"code":"2920741","type":"CDM"},{"code":"361","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE FINGER ABSCESS-FAC","code_information":[{"code":"2920744","type":"CDM"},{"code":"361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METACARPAL FX-FAC","code_information":[{"code":"2920747","type":"CDM"},{"code":"361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METACARPAL FX-FAC","code_information":[{"code":"2920750","type":"CDM"},{"code":"361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX EA-FAC","code_information":[{"code":"2920753","type":"CDM"},{"code":"361","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT PHALANGEAL SHAFT FX-FAC","code_information":[{"code":"2920756","type":"CDM"},{"code":"361","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ARTICULAR FX-FAC","code_information":[{"code":"2920759","type":"CDM"},{"code":"361","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX EA-FAC","code_information":[{"code":"2920762","type":"CDM"},{"code":"361","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TX INTERPHALANGEAL DISLOC-FAC","code_information":[{"code":"2920765","type":"CDM"},{"code":"361","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISE HIP/PELVIS LESION-FAC","code_information":[{"code":"2920768","type":"CDM"},{"code":"361","type":"RC"},{"code":"27043","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"TX PELVIC RING FX-FAC","code_information":[{"code":"2920771","type":"CDM"},{"code":"361","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TAIL BONE FX-FAC","code_information":[{"code":"2920774","type":"CDM"},{"code":"361","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HIP SOCKET FX-FAC","code_information":[{"code":"2920777","type":"CDM"},{"code":"361","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TX OF FEMORAL FX-PROX END-FAC","code_information":[{"code":"2920780","type":"CDM"},{"code":"361","type":"RC"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-FAC","code_information":[{"code":"2920783","type":"CDM"},{"code":"361","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"CL TX POST HIP DISLOC-FAC","code_information":[{"code":"2920786","type":"CDM"},{"code":"361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FEMORAL FX-FAC","code_information":[{"code":"2920789","type":"CDM"},{"code":"361","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":2979.75,"setting":"both","billing_class":"facility"},{"gross_charge":2979.75,"setting":"both","billing_class":"professional"}]},{"description":"ESC TUMOR THIGH/KNEE-FAC","code_information":[{"code":"2920792","type":"CDM"},{"code":"361","type":"RC"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-FAC","code_information":[{"code":"2920795","type":"CDM"},{"code":"361","type":"RC"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FEMORAL FX-FAC","code_information":[{"code":"2920798","type":"CDM"},{"code":"361","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-FAC","code_information":[{"code":"2920801","type":"CDM"},{"code":"361","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-FAC","code_information":[{"code":"2920804","type":"CDM"},{"code":"361","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT KNEECAP FX-FAC","code_information":[{"code":"2920807","type":"CDM"},{"code":"361","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT KNEE FX-FAC","code_information":[{"code":"2920810","type":"CDM"},{"code":"361","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT INTERCOND SPINE FX-FAC","code_information":[{"code":"2920813","type":"CDM"},{"code":"361","type":"RC"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TIBIA FX-FAC","code_information":[{"code":"2920816","type":"CDM"},{"code":"361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-FAC","code_information":[{"code":"2920819","type":"CDM"},{"code":"361","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT POST ANKLE FX-FAC","code_information":[{"code":"2920822","type":"CDM"},{"code":"361","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FIBULA FX-FAC","code_information":[{"code":"2920825","type":"CDM"},{"code":"361","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-FAC","code_information":[{"code":"2920828","type":"CDM"},{"code":"361","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-FAC","code_information":[{"code":"2920831","type":"CDM"},{"code":"361","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT LOWER LEG FX-FAC","code_information":[{"code":"2920834","type":"CDM"},{"code":"361","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT LOWER LEG FX-FAC","code_information":[{"code":"2920837","type":"CDM"},{"code":"361","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT FOREIGN BODY-FAC","code_information":[{"code":"2920840","type":"CDM"},{"code":"361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HEEL FX-FAC","code_information":[{"code":"2920843","type":"CDM"},{"code":"361","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TALUS FX-FAC","code_information":[{"code":"2920846","type":"CDM"},{"code":"361","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT MIDFOOT FX EA-FAC","code_information":[{"code":"2920849","type":"CDM"},{"code":"361","type":"RC"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METATARSAL FX-FAC","code_information":[{"code":"2920852","type":"CDM"},{"code":"361","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT BIG TOE FX-FAC","code_information":[{"code":"2920855","type":"CDM"},{"code":"361","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TOE FX-FAC","code_information":[{"code":"2920858","type":"CDM"},{"code":"361","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TOE FX-FAC","code_information":[{"code":"2920861","type":"CDM"},{"code":"361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TX SESAMOID FX-FAC","code_information":[{"code":"2920864","type":"CDM"},{"code":"361","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"facility"},{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"TX METATARSOPH JNT-FAC","code_information":[{"code":"2920867","type":"CDM"},{"code":"361","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"facility"},{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG ARM CAST-FAC","code_information":[{"code":"2920870","type":"CDM"},{"code":"361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FOREARM CAST-FAC","code_information":[{"code":"2920873","type":"CDM"},{"code":"361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY HAND/WRIST CAST-FAC","code_information":[{"code":"2920876","type":"CDM"},{"code":"361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG ARM SPLINT-FAC","code_information":[{"code":"2920879","type":"CDM"},{"code":"361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":153.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FOREARM SPLINT-FAC","code_information":[{"code":"2920882","type":"CDM"},{"code":"361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"setting":"both","billing_class":"facility"},{"gross_charge":241.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FINGER SPLINT-FAC","code_information":[{"code":"2920885","type":"CDM"},{"code":"361","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"facility"},{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG CAST-FAC","code_information":[{"code":"2920889","type":"CDM"},{"code":"361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG CAST-FAC","code_information":[{"code":"2920892","type":"CDM"},{"code":"361","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-FAC","code_information":[{"code":"2920895","type":"CDM"},{"code":"361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.25,"setting":"both","billing_class":"facility"},{"gross_charge":271.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-FAC","code_information":[{"code":"2920898","type":"CDM"},{"code":"361","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-FAC","code_information":[{"code":"2920901","type":"CDM"},{"code":"361","type":"RC"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG LEG SPLINT-FAC","code_information":[{"code":"2920904","type":"CDM"},{"code":"361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":153.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LOWER LEG SPLINT-FAC","code_information":[{"code":"2920907","type":"CDM"},{"code":"361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.75,"setting":"both","billing_class":"facility"},{"gross_charge":157.75,"setting":"both","billing_class":"professional"}]},{"description":"STRAP ANKLE OR FOOT-FAC","code_information":[{"code":"2920910","type":"CDM"},{"code":"361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"UNNA BOOT STRAPPING-FAC","code_information":[{"code":"2920913","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":153.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY COMPRS LWR LEG-FAC","code_information":[{"code":"2920916","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVISE CAST-FAC","code_information":[{"code":"2920919","type":"CDM"},{"code":"361","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FULL ARM/LEG CAST-FAC","code_information":[{"code":"2920922","type":"CDM"},{"code":"361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"WINDOWING OF CAST-FAC","code_information":[{"code":"2920925","type":"CDM"},{"code":"361","type":"RC"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":153.5,"setting":"both","billing_class":"professional"}]},{"description":"WEDGING OF CAST-FAC","code_information":[{"code":"2920928","type":"CDM"},{"code":"361","type":"RC"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"CASTING/STRAPPING-FAC","code_information":[{"code":"2920931","type":"CDM"},{"code":"361","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":153.5,"setting":"both","billing_class":"professional"}]},{"description":"INTRANASAL BX-FAC","code_information":[{"code":"2921200","type":"CDM"},{"code":"361","type":"RC"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"EX NASAL POLYP-FAC","code_information":[{"code":"2921203","type":"CDM"},{"code":"361","type":"RC"},{"code":"30110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"REM NASAL FOREIGN BODY-FAC","code_information":[{"code":"2921206","type":"CDM"},{"code":"361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"ABLATE INF TURBINATE-FAC","code_information":[{"code":"2921209","type":"CDM"},{"code":"361","type":"RC"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSEBLEED-FAC","code_information":[{"code":"2921212","type":"CDM"},{"code":"361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL NASAL HEMORRHAGE-FAC","code_information":[{"code":"2921215","type":"CDM"},{"code":"361","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.5,"setting":"both","billing_class":"professional"}]},{"description":"NASAL ENDO DX-FAC","code_information":[{"code":"2921218","type":"CDM"},{"code":"361","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.25,"setting":"both","billing_class":"facility"},{"gross_charge":187.25,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX MAX ENDO-FAC","code_information":[{"code":"2921221","type":"CDM"},{"code":"361","type":"RC"},{"code":"31233","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.5,"setting":"both","billing_class":"facility"},{"gross_charge":439.5,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX SPHN ENDO-FAC","code_information":[{"code":"2921224","type":"CDM"},{"code":"361","type":"RC"},{"code":"31235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.25,"setting":"both","billing_class":"facility"},{"gross_charge":1555.25,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC BX POLYPC-FAC","code_information":[{"code":"2921227","type":"CDM"},{"code":"361","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.25,"setting":"both","billing_class":"facility"},{"gross_charge":1555.25,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGOSCOPY DX-FAC","code_information":[{"code":"2921233","type":"CDM"},{"code":"361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.25,"setting":"both","billing_class":"facility"},{"gross_charge":187.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ THERAPY OF VEINS-FAC","code_information":[{"code":"2921238","type":"CDM"},{"code":"361","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION TONGUE FOLD-FAC","code_information":[{"code":"2921239","type":"CDM"},{"code":"361","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-FAC","code_information":[{"code":"2921241","type":"CDM"},{"code":"361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"setting":"both","billing_class":"facility"},{"gross_charge":787.0,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-FAC","code_information":[{"code":"2921244","type":"CDM"},{"code":"361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.25,"setting":"both","billing_class":"facility"},{"gross_charge":997.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF LIP-FAC","code_information":[{"code":"2921500","type":"CDM"},{"code":"361","type":"RC"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"setting":"both","billing_class":"facility"},{"gross_charge":431.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF LIP FOLD-FAC","code_information":[{"code":"2921503","type":"CDM"},{"code":"361","type":"RC"},{"code":"40806","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"setting":"both","billing_class":"facility"},{"gross_charge":554.0,"setting":"both","billing_class":"professional"}]},{"description":"BX VESTIBULE OF MOUTH-FAC","code_information":[{"code":"2921506","type":"CDM"},{"code":"361","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"setting":"both","billing_class":"facility"},{"gross_charge":554.0,"setting":"both","billing_class":"professional"}]},{"description":"EX MOUTH LESION-FAC","code_information":[{"code":"2921509","type":"CDM"},{"code":"361","type":"RC"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISE/REPAIR MOUTH LESION-FAC","code_information":[{"code":"2921512","type":"CDM"},{"code":"361","type":"RC"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"BX TONGUE ANTERIOR 2/3-FAC","code_information":[{"code":"2921518","type":"CDM"},{"code":"361","type":"RC"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"setting":"both","billing_class":"facility"},{"gross_charge":554.0,"setting":"both","billing_class":"professional"}]},{"description":"EXISE TONGUE LESION-FAC","code_information":[{"code":"2921521","type":"CDM"},{"code":"361","type":"RC"},{"code":"41110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"EX LINGUAL FRENUM-FAC","code_information":[{"code":"2921524","type":"CDM"},{"code":"361","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION PALATE UVULA-FAC","code_information":[{"code":"2921527","type":"CDM"},{"code":"361","type":"RC"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION PALATE UVULA-FAC","code_information":[{"code":"2921530","type":"CDM"},{"code":"361","type":"RC"},{"code":"42106","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF SALIVARY GLAND-FAC","code_information":[{"code":"2921533","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.5,"setting":"both","billing_class":"facility"},{"gross_charge":1085.5,"setting":"both","billing_class":"professional"}]},{"description":"I&D ABSCESS;PERITONSILLAR-FAC","code_information":[{"code":"2921536","type":"CDM"},{"code":"361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.75,"setting":"both","billing_class":"facility"},{"gross_charge":361.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OROPHARYNX-FAC","code_information":[{"code":"2921539","type":"CDM"},{"code":"361","type":"RC"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"EXISE PHARYNX LESION-FAC","code_information":[{"code":"2921542","type":"CDM"},{"code":"361","type":"RC"},{"code":"42808","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE GASTROSTOMY TUBE-FAC","code_information":[{"code":"2921545","type":"CDM"},{"code":"361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"setting":"both","billing_class":"facility"},{"gross_charge":242.0,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSCOPY;DX-FAC","code_information":[{"code":"2921548","type":"CDM"},{"code":"361","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"setting":"both","billing_class":"facility"},{"gross_charge":847.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE RECTAL ABSCESS-FAC","code_information":[{"code":"2921551","type":"CDM"},{"code":"361","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.5,"setting":"both","billing_class":"facility"},{"gross_charge":1914.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISE ANAL ABSCESS-FAC","code_information":[{"code":"2921554","type":"CDM"},{"code":"361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"setting":"both","billing_class":"facility"},{"gross_charge":847.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE EXT HEMORRHOID-FAC","code_information":[{"code":"2921557","type":"CDM"},{"code":"361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"LIGATION OF HEMORRHOIDS-FAC","code_information":[{"code":"2921560","type":"CDM"},{"code":"361","type":"RC"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"setting":"both","billing_class":"facility"},{"gross_charge":847.0,"setting":"both","billing_class":"professional"}]},{"description":"REM ANAL TAGS-FAC","code_information":[{"code":"2921563","type":"CDM"},{"code":"361","type":"RC"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.75,"setting":"both","billing_class":"facility"},{"gross_charge":2651.75,"setting":"both","billing_class":"professional"}]},{"description":"REM HEMORRHOID CLOT-FAC","code_information":[{"code":"2921566","type":"CDM"},{"code":"361","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1953.25,"setting":"both","billing_class":"facility"},{"gross_charge":1953.25,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY DIAGNOSTIC-FAC","code_information":[{"code":"2921569","type":"CDM"},{"code":"361","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY W DILATION-FAC","code_information":[{"code":"2921572","type":"CDM"},{"code":"361","type":"RC"},{"code":"46604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.5,"setting":"both","billing_class":"facility"},{"gross_charge":1914.5,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY; W BX-FAC","code_information":[{"code":"2921575","type":"CDM"},{"code":"361","type":"RC"},{"code":"46606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.5,"setting":"both","billing_class":"facility"},{"gross_charge":1914.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT ANAL LESION-FAC","code_information":[{"code":"2921578","type":"CDM"},{"code":"361","type":"RC"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"EX OF ANAL LESION-FAC","code_information":[{"code":"2921581","type":"CDM"},{"code":"361","type":"RC"},{"code":"46922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.75,"setting":"both","billing_class":"facility"},{"gross_charge":2651.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EA-FAC","code_information":[{"code":"2921582","type":"CDM"},{"code":"361","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EA-FAC","code_information":[{"code":"2921583","type":"CDM"},{"code":"361","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE DUOD/JEJ TUBE-FAC","code_information":[{"code":"2921584","type":"CDM"},{"code":"361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.75,"setting":"both","billing_class":"facility"},{"gross_charge":865.75,"setting":"both","billing_class":"professional"}]},{"description":"IRRIGATION OF BLADDER-FAC","code_information":[{"code":"2921800","type":"CDM"},{"code":"361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT BLADDER CATHETER-FAC","code_information":[{"code":"2921803","type":"CDM"},{"code":"361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TEMP BLADDER CATH-FAC","code_information":[{"code":"2921806","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE BLADDER TUBE-FAC","code_information":[{"code":"2921809","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"UROCUFF TEST-FAC","code_information":[{"code":"2921813","type":"CDM"},{"code":"361","type":"RC"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"},{"gross_charge":639.0,"setting":"both","modifiers":"52","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"ELECTRO/UROFLOWMETRY 1ST-FAC","code_information":[{"code":"2921815","type":"CDM"},{"code":"361","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.5,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-FAC","code_information":[{"code":"2921818","type":"CDM"},{"code":"361","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.75,"setting":"both","billing_class":"facility"},{"gross_charge":222.75,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-FAC","code_information":[{"code":"2921821","type":"CDM"},{"code":"361","type":"RC"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"INTRAABDOM PRESSURE TST-FAC","code_information":[{"code":"2921824","type":"CDM"},{"code":"920","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"facility"},{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"US URINE CAPACITY MEASURE-FAC","code_information":[{"code":"2921827","type":"CDM"},{"code":"361","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.5,"setting":"both","billing_class":"facility"},{"gross_charge":107.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY-FAC","code_information":[{"code":"2921830","type":"CDM"},{"code":"361","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.25,"setting":"both","billing_class":"facility"},{"gross_charge":741.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY W BX  FAC-FAC","code_information":[{"code":"2921833","type":"CDM"},{"code":"361","type":"RC"},{"code":"52204","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-FAC","code_information":[{"code":"2921836","type":"CDM"},{"code":"361","type":"RC"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-FAC","code_information":[{"code":"2921841","type":"CDM"},{"code":"361","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-FAC","code_information":[{"code":"2921844","type":"CDM"},{"code":"361","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE URETHRA STRICTURE-FAC","code_information":[{"code":"2921847","type":"CDM"},{"code":"361","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"DILATE FEM URETHRA INIT-FAC","code_information":[{"code":"2921850","type":"CDM"},{"code":"361","type":"RC"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE FEM URETHRA SUBS-FAC","code_information":[{"code":"2921853","type":"CDM"},{"code":"361","type":"RC"},{"code":"53661","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY LESION PENIS;CHEM-FAC","code_information":[{"code":"2921856","type":"CDM"},{"code":"361","type":"RC"},{"code":"54050","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT PENIS LESION-FAC","code_information":[{"code":"2921859","type":"CDM"},{"code":"361","type":"RC"},{"code":"54055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.0,"setting":"both","billing_class":"facility"},{"gross_charge":1760.0,"setting":"both","billing_class":"professional"}]},{"description":"CRYOSURGERY PENIS LESION-FAC","code_information":[{"code":"2921862","type":"CDM"},{"code":"361","type":"RC"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS PENIL CIRCUMCISION-FAC","code_information":[{"code":"2921865","type":"CDM"},{"code":"361","type":"RC"},{"code":"54162","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ FOR PEYRONIE DIS-FAC","code_information":[{"code":"2921868","type":"CDM"},{"code":"361","type":"RC"},{"code":"54200","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"PREPUTIAL STRETCHING-FAC","code_information":[{"code":"2921871","type":"CDM"},{"code":"361","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"I&D EPIDIDYMIS TSTIS/SCR-FAC","code_information":[{"code":"2921874","type":"CDM"},{"code":"361","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE ASPIR VAGINALIS-FAC","code_information":[{"code":"2921877","type":"CDM"},{"code":"361","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN SCROTAL WALL ABSC-FAC","code_information":[{"code":"2921880","type":"CDM"},{"code":"361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPERM DUCT-FAC","code_information":[{"code":"2921883","type":"CDM"},{"code":"361","type":"RC"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.25,"setting":"both","billing_class":"facility"},{"gross_charge":2139.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF PROSTATE-FAC","code_information":[{"code":"2921886","type":"CDM"},{"code":"361","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"I & D VULVA/PERINEUM-FAC","code_information":[{"code":"2921889","type":"CDM"},{"code":"361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.5,"setting":"both","billing_class":"facility"},{"gross_charge":317.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF GLAND ABSCESS-FAC","code_information":[{"code":"2921892","type":"CDM"},{"code":"361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"facility"},{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VULVA LESIONS SIM-FAC","code_information":[{"code":"2921895","type":"CDM"},{"code":"361","type":"RC"},{"code":"56501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.5,"setting":"both","billing_class":"facility"},{"gross_charge":1875.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VULVA LESION CMPLX-FAC","code_information":[{"code":"2921898","type":"CDM"},{"code":"361","type":"RC"},{"code":"56515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.5,"setting":"both","billing_class":"facility"},{"gross_charge":1875.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-FAC","code_information":[{"code":"2921901","type":"CDM"},{"code":"361","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.75,"setting":"both","billing_class":"facility"},{"gross_charge":634.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-FAC","code_information":[{"code":"2921904","type":"CDM"},{"code":"361","type":"RC"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"facility"},{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VAGINAL LESION-FAC","code_information":[{"code":"2921907","type":"CDM"},{"code":"361","type":"RC"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.5,"setting":"both","billing_class":"facility"},{"gross_charge":2681.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VAGINAL LESIONS-FAC","code_information":[{"code":"2921910","type":"CDM"},{"code":"361","type":"RC"},{"code":"57065","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.5,"setting":"both","billing_class":"facility"},{"gross_charge":2681.5,"setting":"both","billing_class":"professional"}]},{"description":"BX VAGINAL MUCOSA-FAC","code_information":[{"code":"2921913","type":"CDM"},{"code":"361","type":"RC"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.5,"setting":"both","billing_class":"facility"},{"gross_charge":734.5,"setting":"both","billing_class":"professional"}]},{"description":"INSERT PESSARY/OTH IMPL-FAC","code_information":[{"code":"2921916","type":"CDM"},{"code":"361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"facility"},{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"EXAM/BX VAG W SCOPE-FAC","code_information":[{"code":"2921919","type":"CDM"},{"code":"361","type":"RC"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.5,"setting":"both","billing_class":"facility"},{"gross_charge":734.5,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY OF CERVIX-FAC","code_information":[{"code":"2921922","type":"CDM"},{"code":"361","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"facility"},{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"BX/CURETT CERVIX W SCOPE-FAC","code_information":[{"code":"2921925","type":"CDM"},{"code":"361","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.5,"setting":"both","billing_class":"facility"},{"gross_charge":317.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX W/SCOPE LEEP-FAC","code_information":[{"code":"2921928","type":"CDM"},{"code":"361","type":"RC"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"setting":"both","billing_class":"facility"},{"gross_charge":3215.0,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY CERV W/SC LEEP-FAC","code_information":[{"code":"2921929","type":"CDM"},{"code":"361","type":"RC"},{"code":"57461","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"setting":"both","billing_class":"facility"},{"gross_charge":3215.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX-FAC","code_information":[{"code":"2921931","type":"CDM"},{"code":"361","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.5,"setting":"both","billing_class":"facility"},{"gross_charge":734.5,"setting":"both","billing_class":"professional"}]},{"description":"CONIZATION OF CERVIX-FAC","code_information":[{"code":"2921934","type":"CDM"},{"code":"361","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"setting":"both","billing_class":"facility"},{"gross_charge":3215.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF UTERUS LINING-FAC","code_information":[{"code":"2921937","type":"CDM"},{"code":"361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.25,"setting":"both","billing_class":"facility"},{"gross_charge":268.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT INTRAUTERINE DEV-FAC","code_information":[{"code":"2921940","type":"CDM"},{"code":"361","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"REM INTRAUTERINE DEVICE-FAC","code_information":[{"code":"2921943","type":"CDM"},{"code":"361","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.5,"setting":"both","billing_class":"facility"},{"gross_charge":317.5,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL PUNCTURE LUMBAR-FAC","code_information":[{"code":"2922200","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.5,"setting":"both","billing_class":"facility"},{"gross_charge":710.5,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ TRIGEMINAL-FAC","code_information":[{"code":"2922203","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"facility"},{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  OCCIP BIL-FAC","code_information":[{"code":"2922206","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NERVE BLOCK INJ PUDENDAL-FAC","code_information":[{"code":"2922209","type":"CDM"},{"code":"361","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.25,"setting":"both","billing_class":"facility"},{"gross_charge":869.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK OTHER PERIPHERAL-FAC","code_information":[{"code":"2922212","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"setting":"both","billing_class":"facility"},{"gross_charge":681.0,"setting":"both","billing_class":"professional"}]},{"description":"NERVE BLOCK PLANTAR DIGIT-FAC","code_information":[{"code":"2922215","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTR W NEUROLYTIC AGENT-FAC","code_information":[{"code":"2922217","type":"CDM"},{"code":"361","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.25,"setting":"both","billing_class":"facility"},{"gross_charge":869.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN SALIV GLANDS-FAC","code_information":[{"code":"2922218","type":"CDM"},{"code":"361","type":"RC"},{"code":"64611","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE-FACE MUSC-FAC","code_information":[{"code":"2922221","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC MIGRAINE-FAC","code_information":[{"code":"2922224","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK DYS-FAC","code_information":[{"code":"2922227","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.5,"setting":"both","billing_class":"facility"},{"gross_charge":441.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 1-4 MUSC-FAC","code_information":[{"code":"2922230","type":"CDM"},{"code":"361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"setting":"both","billing_class":"facility"},{"gross_charge":681.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXT 1-4 ADDL-FAC","code_information":[{"code":"2922233","type":"CDM"},{"code":"361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":93.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTREM 5/> MUS-FAC","code_information":[{"code":"2922236","type":"CDM"},{"code":"361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.5,"setting":"both","billing_class":"facility"},{"gross_charge":688.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EX 5/> EA ADDL-FAC","code_information":[{"code":"2922239","type":"CDM"},{"code":"361","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"EX NEUROMA CUTANEOUS-FAC","code_information":[{"code":"2922242","type":"CDM"},{"code":"361","type":"RC"},{"code":"64774","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.5,"setting":"both","billing_class":"facility"},{"gross_charge":1853.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FROM EYE-FAC","code_information":[{"code":"2922245","type":"CDM"},{"code":"361","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROTOMY DRAIN ABSC-FAC","code_information":[{"code":"2922248","type":"CDM"},{"code":"361","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.75,"setting":"both","billing_class":"facility"},{"gross_charge":322.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE EXT EAR ABSC-FAC","code_information":[{"code":"2922251","type":"CDM"},{"code":"361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE EXT EAR ABSCESS-FAC","code_information":[{"code":"2922254","type":"CDM"},{"code":"361","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF EXTERNAL EAR-FAC","code_information":[{"code":"2922257","type":"CDM"},{"code":"361","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.75,"setting":"both","billing_class":"facility"},{"gross_charge":509.75,"setting":"both","billing_class":"professional"}]},{"description":"BX EXT AUDITORY CANAL-FAC","code_information":[{"code":"2922260","type":"CDM"},{"code":"361","type":"RC"},{"code":"69105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"CLEAR OUTER EAR CANAL-FAC","code_information":[{"code":"2922263","type":"CDM"},{"code":"361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPCT EARWAX W/TOOL-FAC","code_information":[{"code":"2922269","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"CLEAN OUT MASTOID CAVITY-FAC","code_information":[{"code":"2922272","type":"CDM"},{"code":"361","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"MYRINGOTOMY-FAC","code_information":[{"code":"2922275","type":"CDM"},{"code":"361","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"setting":"both","billing_class":"facility"},{"gross_charge":431.0,"setting":"both","billing_class":"professional"}]},{"description":"CREATE EARDRUM OPENING-FAC","code_information":[{"code":"2922278","type":"CDM"},{"code":"361","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"setting":"both","billing_class":"facility"},{"gross_charge":554.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE INNER EAR-FAC","code_information":[{"code":"2922281","type":"CDM"},{"code":"361","type":"RC"},{"code":"69801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.25,"setting":"both","billing_class":"facility"},{"gross_charge":1453.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE 1 OR 2 VW LT-FAC/TEC","code_information":[{"code":"2922401","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 3 VIEW LT-FAC/TEC","code_information":[{"code":"2922402","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":113.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 4 VIEW LT-FAC/TEC","code_information":[{"code":"2922403","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","modifiers":"TC|LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":130.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"REM IMPACTED EARWAX BIL-FAC","code_information":[{"code":"2922404","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":95.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM EYELID LESIONS BIL-FAC","code_information":[{"code":"2922405","type":"CDM"},{"code":"361","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1561.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSE TEAR DUCTS OPEN BIL-FAC","code_information":[{"code":"2922406","type":"CDM"},{"code":"361","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":455.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BX OF CERVIX W/SCOPE-FAC","code_information":[{"code":"2922407","type":"CDM"},{"code":"360","type":"RC"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.5,"setting":"both","billing_class":"facility"},{"gross_charge":346.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPEN BIL-FAC","code_information":[{"code":"2922408","type":"CDM"},{"code":"361","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":614.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED PX LUNGS & PLEURA-FAC","code_information":[{"code":"2922411","type":"CDM"},{"code":"361","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"setting":"both","billing_class":"facility"},{"gross_charge":678.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 30MINS-FAC","code_information":[{"code":"2922412","type":"CDM"},{"code":"914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 45MINS-FAC","code_information":[{"code":"2922413","type":"CDM"},{"code":"914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 60MINS-FAC","code_information":[{"code":"2922414","type":"CDM"},{"code":"914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UP LID BIL-FAC","code_information":[{"code":"2922415","type":"CDM"},{"code":"361","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":2813.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":2813.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REMOVAL OF IMPLANT DEEP-FAC","code_information":[{"code":"2922416","type":"CDM"},{"code":"360","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2922.25,"setting":"both","billing_class":"facility"},{"gross_charge":2922.25,"setting":"both","billing_class":"professional"}]},{"description":"PLETHYSMOGRAPHY (PFT)-FAC","code_information":[{"code":"2922417","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"setting":"both","billing_class":"facility"},{"gross_charge":323.0,"setting":"both","billing_class":"professional"}]},{"description":"DIFFUSING CAPACITY-FAC","code_information":[{"code":"2922418","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.75,"setting":"both","billing_class":"facility"},{"gross_charge":70.75,"setting":"both","billing_class":"professional"}]},{"description":"ABD PARACENTESIS W/IMAGE-FAC","code_information":[{"code":"2922419","type":"CDM"},{"code":"361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.25,"setting":"both","billing_class":"facility"},{"gross_charge":932.25,"setting":"both","billing_class":"professional"}]},{"description":"ESCHAROTOMY 1ST INCISION-FAC","code_information":[{"code":"2922425","type":"CDM"},{"code":"360","type":"RC"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.75,"setting":"both","billing_class":"facility"},{"gross_charge":443.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF RIBS-FAC/TECH","code_information":[{"code":"2922500","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY BREASTBONE-FAC","code_information":[{"code":"2922503","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-FAC","code_information":[{"code":"2922506","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":113.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-FAC/TECH","code_information":[{"code":"2922509","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY OF NECK/SPINE-FAC/TECH","code_information":[{"code":"2922512","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.5,"setting":"both","billing_class":"facility"},{"gross_charge":131.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY THORACIC SPINE-FAC/TECH","code_information":[{"code":"2922515","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY SPINE 2VIEWS&>-FAC","code_information":[{"code":"2922518","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPINE-FAC/TECH","code_information":[{"code":"2922521","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.5,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY LOWER SPINE-FAC/TECH","code_information":[{"code":"2922524","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY LOWER SPINE-FAC/TECH","code_information":[{"code":"2922527","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY OF PELVIS-FAC/TECH","code_information":[{"code":"2922530","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY TAILBONE-FAC/TECH","code_information":[{"code":"2922533","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY COLLAR BONE-FAC/TECH","code_information":[{"code":"2922536","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY SHOULDER BLADE-FAC","code_information":[{"code":"2922539","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER-FAC/TECH","code_information":[{"code":"2922542","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY SHOULDER 2 VW RT-FAC/TEC","code_information":[{"code":"2922545","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":113.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY SHOULDERS-FAC","code_information":[{"code":"2922548","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":113.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDR CMPL BIL-FAC/TECH","code_information":[{"code":"2922549","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":227.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY HUMERUS-FAC/TECH","code_information":[{"code":"2922551","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY ELBOW-FAC/TECH","code_information":[{"code":"2922554","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY ELBOW 3 VIEW RT-FAC/TEC","code_information":[{"code":"2922557","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FOREARM-FAC/TECH","code_information":[{"code":"2922560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY WRIST-FAC/TECH","code_information":[{"code":"2922563","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY WRIST 3 VIEW RT-FAC/TEC","code_information":[{"code":"2922566","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HAND-FAC/TECH","code_information":[{"code":"2922569","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY HAND 3 VIEW RT-FAC/TEC","code_information":[{"code":"2922572","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FINGER-FAC/TECH","code_information":[{"code":"2922575","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP UNI 1 VIEW-FAC/TECH","code_information":[{"code":"2922578","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.75,"setting":"both","billing_class":"facility"},{"gross_charge":92.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY HIP 2-3 VIEW RT-FAC/TEC","code_information":[{"code":"2922581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HIP 4 OR >VIEW-FAC/TECH","code_information":[{"code":"2922584","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY HIP BI 2 VIEW-FAC","code_information":[{"code":"2922587","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP BI 3 OR 4V-FAC/TECH","code_information":[{"code":"2922590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY HIP BI 5 OR >V-FAC","code_information":[{"code":"2922593","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":260.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FEMUR 1 VIEW-FAC/TECH","code_information":[{"code":"2922596","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY OF FEMUR 2/>-FAC/TECH","code_information":[{"code":"2922599","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY KNEE 1 OR 2 VW RT-FAC/TEC","code_information":[{"code":"2922602","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":93.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 3 VIEW RT-FAC/TEC","code_information":[{"code":"2922605","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":113.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 4 VIEW RT-FAC/TEC","code_information":[{"code":"2922608","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","modifiers":"TC|RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":130.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEES BIL STAND-FAC/TECH","code_information":[{"code":"2922611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY LOWER LEG-FAC/TECH","code_information":[{"code":"2922614","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"facility"},{"gross_charge":94.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY OF LEG INFANT-FAC","code_information":[{"code":"2922617","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":113.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ANKLE-FAC/TECH","code_information":[{"code":"2922620","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":113.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY ANKLE-FAC/TECH","code_information":[{"code":"2922623","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":113.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY KNEE BILATERAL-FAC/TECH","code_information":[{"code":"2922624","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 3V BILAT-FAC/TECH","code_information":[{"code":"2922625","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":286.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY FOOT-FAC/TECH","code_information":[{"code":"2922626","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY FOOT-FAC/TECH","code_information":[{"code":"2922629","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY HEEL-FAC/TECH","code_information":[{"code":"2922632","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY TOE-FAC/TECH","code_information":[{"code":"2922635","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND HEAD AND NECK-FAC","code_information":[{"code":"2922638","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.5,"setting":"both","billing_class":"facility"},{"gross_charge":131.5,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND TRANSRECTAL-FAC","code_information":[{"code":"2922641","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.75,"setting":"both","billing_class":"facility"},{"gross_charge":177.75,"setting":"both","billing_class":"professional"}]},{"description":"ECHO GUIDE FOR BX-FAC","code_information":[{"code":"2922644","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND RETROPERITONEAL-FAC","code_information":[{"code":"2922647","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.5,"setting":"both","billing_class":"facility"},{"gross_charge":113.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MNL APPL STRESS JNT-FAC","code_information":[{"code":"2922648","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"},{"gross_charge":98.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"BREATH HYDROGEN TST-FAC","code_information":[{"code":"2923343","type":"CDM"},{"code":"920","type":"RC"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.25,"setting":"both","billing_class":"facility"},{"gross_charge":168.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG ANT-FAC","code_information":[{"code":"2923346","type":"CDM"},{"code":"920","type":"RC"},{"code":"92132","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH IMG OPTIC NRV-FAC","code_information":[{"code":"2923349","type":"CDM"},{"code":"920","type":"RC"},{"code":"92133","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG POST-FAC","code_information":[{"code":"2923352","type":"CDM"},{"code":"920","type":"RC"},{"code":"92134","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"EAR MICROSCOPY EXAM-FAC","code_information":[{"code":"2923355","type":"CDM"},{"code":"920","type":"RC"},{"code":"92504","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"setting":"both","billing_class":"facility"},{"gross_charge":119.0,"setting":"both","billing_class":"professional"}]},{"description":"COLARIC VESTIBULAR TST-FAC","code_information":[{"code":"2923358","type":"CDM"},{"code":"470","type":"RC"},{"code":"92537","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.5,"setting":"both","billing_class":"facility"},{"gross_charge":254.5,"setting":"both","billing_class":"professional"}]},{"description":"CALORIC VESTIBULAR TST-FAC","code_information":[{"code":"2923361","type":"CDM"},{"code":"470","type":"RC"},{"code":"92538","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.75,"setting":"both","billing_class":"facility"},{"gross_charge":155.75,"setting":"both","billing_class":"professional"}]},{"description":"BASIC VESTIBULAR EVAL-FAC","code_information":[{"code":"2923364","type":"CDM"},{"code":"470","type":"RC"},{"code":"92540","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.25,"setting":"both","billing_class":"facility"},{"gross_charge":170.25,"setting":"both","billing_class":"professional"}]},{"description":"SPONTANEOUS NYSTAGMUS TST-FAC","code_information":[{"code":"2923367","type":"CDM"},{"code":"470","type":"RC"},{"code":"92541","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"COMPREHENSIVE HEARING TST-FAC","code_information":[{"code":"2923370","type":"CDM"},{"code":"471","type":"RC"},{"code":"92557","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.5,"setting":"both","billing_class":"professional"}]},{"description":"TYMPANOMETRY-FAC","code_information":[{"code":"2923373","type":"CDM"},{"code":"471","type":"RC"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.5,"setting":"both","billing_class":"facility"},{"gross_charge":51.5,"setting":"both","billing_class":"professional"}]},{"description":"BREATHING CAPACITY TST-FAC","code_information":[{"code":"2923388","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.5,"setting":"both","billing_class":"facility"},{"gross_charge":191.5,"setting":"both","billing_class":"professional"}]},{"description":"EVALUATION OF WHEEZING-FAC","code_information":[{"code":"2923391","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"setting":"both","billing_class":"facility"},{"gross_charge":323.0,"setting":"both","billing_class":"professional"}]},{"description":"PUL STRESS TST/SIMP-FAC","code_information":[{"code":"2923394","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST 1 LIMB-FAC","code_information":[{"code":"2923421","type":"CDM"},{"code":"922","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.75,"setting":"both","billing_class":"facility"},{"gross_charge":365.75,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRAN NRV UNIL-FAC","code_information":[{"code":"2923424","type":"CDM"},{"code":"922","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","billing_class":"facility"},{"gross_charge":188.25,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG THORACIC-FAC","code_information":[{"code":"2923427","type":"CDM"},{"code":"361","type":"RC"},{"code":"95869","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.5,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST NONPARASPINAL-FAC","code_information":[{"code":"2923430","type":"CDM"},{"code":"922","type":"RC"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.5,"setting":"both","billing_class":"facility"},{"gross_charge":355.5,"setting":"both","billing_class":"professional"}]},{"description":"GUIDE NERVE DESTR NDL-FAC","code_information":[{"code":"2923433","type":"CDM"},{"code":"922","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.25,"setting":"both","billing_class":"facility"},{"gross_charge":270.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/ NERV TST LIM-FAC","code_information":[{"code":"2923436","type":"CDM"},{"code":"922","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"setting":"both","billing_class":"facility"},{"gross_charge":205.0,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/ NERV TST COMP-FAC","code_information":[{"code":"2923439","type":"CDM"},{"code":"922","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.5,"setting":"both","billing_class":"facility"},{"gross_charge":233.5,"setting":"both","billing_class":"professional"}]},{"description":"MUSC W/ NERV TST NONEX-FAC","code_information":[{"code":"2923442","type":"CDM"},{"code":"922","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.25,"setting":"both","billing_class":"facility"},{"gross_charge":224.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 1-2 NRV CNDJ-FAC","code_information":[{"code":"2923445","type":"CDM"},{"code":"922","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.25,"setting":"both","billing_class":"facility"},{"gross_charge":226.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 3-4 NRV CONDJ-FAC","code_information":[{"code":"2923448","type":"CDM"},{"code":"922","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"setting":"both","billing_class":"facility"},{"gross_charge":287.0,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 5-6 NRV CONDJ-FAC","code_information":[{"code":"2923451","type":"CDM"},{"code":"922","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.75,"setting":"both","billing_class":"facility"},{"gross_charge":323.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 7-8 NRV CONDJ-FAC","code_information":[{"code":"2923454","type":"CDM"},{"code":"922","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.75,"setting":"both","billing_class":"facility"},{"gross_charge":323.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 9-10 NRV CNDJ-FAC","code_information":[{"code":"2923457","type":"CDM"},{"code":"922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.25,"setting":"both","billing_class":"facility"},{"gross_charge":518.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 11-12 NRV CNDJ-FAC","code_information":[{"code":"2923460","type":"CDM"},{"code":"922","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.25,"setting":"both","billing_class":"facility"},{"gross_charge":518.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 13&> NRV CNDJ-FAC","code_information":[{"code":"2923463","type":"CDM"},{"code":"922","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.25,"setting":"both","billing_class":"facility"},{"gross_charge":518.25,"setting":"both","billing_class":"professional"}]},{"description":"CANALITH REPOSITIONING-FAC","code_information":[{"code":"2923469","type":"CDM"},{"code":"940","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.75,"setting":"both","billing_class":"facility"},{"gross_charge":220.75,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE ACTIVE 20CM&<-FAC","code_information":[{"code":"2923481","type":"CDM"},{"code":"361","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":260.75,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE SEL >20 SQ-FAC","code_information":[{"code":"2923484","type":"CDM"},{"code":"361","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"setting":"both","billing_class":"facility"},{"gross_charge":15.0,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE VAC <50 SQ-FAC","code_information":[{"code":"2923487","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE NEG PRES-FAC","code_information":[{"code":"2923490","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.5,"setting":"both","billing_class":"facility"},{"gross_charge":336.5,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 1-2 REGNS-FAC","code_information":[{"code":"2923493","type":"CDM"},{"code":"530","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"setting":"both","billing_class":"facility"},{"gross_charge":57.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 3-4 REGNS-FAC","code_information":[{"code":"2923496","type":"CDM"},{"code":"530","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.75,"setting":"both","billing_class":"facility"},{"gross_charge":75.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 2 NEW-FAC","code_information":[{"code":"2923509","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 3 NEW-FAC","code_information":[{"code":"2923510","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 4 NEW-FAC","code_information":[{"code":"2923511","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 5 NEW-FAC","code_information":[{"code":"2923514","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 1 EST-FAC","code_information":[{"code":"2923515","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 2 EST-FAC","code_information":[{"code":"2923516","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 3 EST-FAC","code_information":[{"code":"2923517","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 4 EST-FAC","code_information":[{"code":"2923518","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 5 EST-FAC","code_information":[{"code":"2923519","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT STRT FWD-FAC","code_information":[{"code":"2923521","type":"CDM"},{"code":"510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT MOD LEVEL-FAC","code_information":[{"code":"2923522","type":"CDM"},{"code":"510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT HIGH LEVEL-FAC","code_information":[{"code":"2923523","type":"CDM"},{"code":"510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  INFANT-FAC","code_information":[{"code":"2923524","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  AGE 1-4-FAC","code_information":[{"code":"2923525","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  AGE 5-11-FAC","code_information":[{"code":"2923526","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 12-17-FAC","code_information":[{"code":"2923527","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 18-39-FAC","code_information":[{"code":"2923528","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 40-64-FAC","code_information":[{"code":"2923529","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW 65 & OVER-FAC","code_information":[{"code":"2923530","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  INFANT-FAC","code_information":[{"code":"2923531","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  AGE 1-4-FAC","code_information":[{"code":"2923532","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  AGE 5-11-FAC","code_information":[{"code":"2923533","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 12-17-FAC","code_information":[{"code":"2923534","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 18-39-FAC","code_information":[{"code":"2923535","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 40-64-FAC","code_information":[{"code":"2923536","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST 65 & OVER-FAC","code_information":[{"code":"2923537","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT LOW LEVEL-FAC","code_information":[{"code":"2923549","type":"CDM"},{"code":"510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL PREVENTATIVE EXAM-FAC","code_information":[{"code":"2923881","type":"CDM"},{"code":"770","type":"RC"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"GEL ONE-FAC","code_information":[{"code":"2924054","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7326","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.75,"setting":"both","billing_class":"facility"}]},{"description":"TPRNL BIODEGRADE MATRL-FAC","code_information":[{"code":"2925014","type":"CDM"},{"code":"361","type":"RC"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5043.0,"setting":"both","billing_class":"facility"},{"gross_charge":5043.0,"setting":"both","billing_class":"professional"}]},{"description":"PLACE DEVICE/MARKER-FAC","code_information":[{"code":"2925015","type":"CDM"},{"code":"361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1354.5,"setting":"both","billing_class":"facility"},{"gross_charge":1354.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SKIN/MSCL FX-FAC","code_information":[{"code":"2925016","type":"CDM"},{"code":"361","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE LES F/E/N/L >2CM-FAC","code_information":[{"code":"2925017","type":"CDM"},{"code":"361","type":"RC"},{"code":"11313","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/O IMAGE ADDL-FAC","code_information":[{"code":"2925018","type":"CDM"},{"code":"361","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.75,"setting":"both","billing_class":"facility"},{"gross_charge":52.75,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN-FAC","code_information":[{"code":"2925019","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"setting":"both","billing_class":"facility"},{"gross_charge":659.0,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN ADDL-FAC","code_information":[{"code":"2925020","type":"CDM"},{"code":"361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-FAC","code_information":[{"code":"2925021","type":"CDM"},{"code":"361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN SINGLE LES-FAC","code_information":[{"code":"2925069","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"setting":"both","billing_class":"facility"},{"gross_charge":412.0,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN EA SEP/ADDL-FAC","code_information":[{"code":"2925070","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"setting":"both","billing_class":"facility"},{"gross_charge":37.0,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN EA SEP/ADDL-FAC","code_information":[{"code":"2925072","type":"CDM"},{"code":"361","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.25,"setting":"both","billing_class":"facility"},{"gross_charge":42.25,"setting":"both","billing_class":"professional"}]},{"description":"DEB MSC/FASCIA ADDL =<20CM-FAC","code_information":[{"code":"2925073","type":"CDM"},{"code":"361","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.75,"setting":"both","billing_class":"facility"},{"gross_charge":222.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC F/E/N/L MAL 0.5CM<-FAC","code_information":[{"code":"2925074","type":"CDM"},{"code":"361","type":"RC"},{"code":"11640","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.5,"setting":"both","billing_class":"facility"},{"gross_charge":758.5,"setting":"both","billing_class":"professional"}]},{"description":"I&D FOREARM/WRIST-FAC","code_information":[{"code":"2925077","type":"CDM"},{"code":"361","type":"RC"},{"code":"25031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"CL TX MALLET FINGER-FAC","code_information":[{"code":"2925078","type":"CDM"},{"code":"361","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"CL TX TARSAL DISLOCATION-FAC","code_information":[{"code":"2925079","type":"CDM"},{"code":"361","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL NASAL HEMORR-FAC","code_information":[{"code":"2925080","type":"CDM"},{"code":"361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.25,"setting":"both","billing_class":"facility"},{"gross_charge":121.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE FB EYE-FAC","code_information":[{"code":"2925081","type":"CDM"},{"code":"361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.5,"setting":"both","billing_class":"facility"},{"gross_charge":396.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE FB EYE-FAC","code_information":[{"code":"2925082","type":"CDM"},{"code":"361","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.25,"setting":"both","billing_class":"facility"},{"gross_charge":121.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE LES S/N/H/F/G >2CM-FAC","code_information":[{"code":"2925095","type":"CDM"},{"code":"361","type":"RC"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC F/E/E/N/L >4CM-FAC","code_information":[{"code":"2925096","type":"CDM"},{"code":"361","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LES S/N/EX G >4CM-FAC","code_information":[{"code":"2925097","type":"CDM"},{"code":"361","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ INTO SKIN LES >7-FAC","code_information":[{"code":"2925098","type":"CDM"},{"code":"361","type":"RC"},{"code":"11901","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND S/N/A/T/E-FAC","code_information":[{"code":"2925099","type":"CDM"},{"code":"361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND F/E/N/L-FAC","code_information":[{"code":"2925100","type":"CDM"},{"code":"361","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND F/E/N/L-FAC","code_information":[{"code":"2925101","type":"CDM"},{"code":"361","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"TX WND DEHIS-FAC","code_information":[{"code":"2925102","type":"CDM"},{"code":"361","type":"RC"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-FAC","code_information":[{"code":"2925103","type":"CDM"},{"code":"361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-FAC","code_information":[{"code":"2925104","type":"CDM"},{"code":"361","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.5,"setting":"both","billing_class":"facility"},{"gross_charge":548.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/T/E-FAC","code_information":[{"code":"2925105","type":"CDM"},{"code":"361","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.0,"setting":"both","billing_class":"facility"},{"gross_charge":1760.0,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND N/H/F/E-FAC","code_information":[{"code":"2925106","type":"CDM"},{"code":"361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND N/H/F/E-FAC","code_information":[{"code":"2925107","type":"CDM"},{"code":"361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.5,"setting":"both","billing_class":"facility"},{"gross_charge":548.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/E/N/L/MM 5.1-7.5-FAC","code_information":[{"code":"2925108","type":"CDM"},{"code":"361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 12.6-20-FAC","code_information":[{"code":"2925109","type":"CDM"},{"code":"361","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.5,"setting":"both","billing_class":"facility"},{"gross_charge":548.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 20.1-30-FAC","code_information":[{"code":"2925110","type":"CDM"},{"code":"361","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 30+FAC","code_information":[{"code":"2925111","type":"CDM"},{"code":"361","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.75,"setting":"both","billing_class":"facility"},{"gross_charge":1758.75,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 5.1-7.5-FAC","code_information":[{"code":"2925112","type":"CDM"},{"code":"361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 7.6-12.5-FAC","code_information":[{"code":"2925113","type":"CDM"},{"code":"361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 12.6-20-FAC","code_information":[{"code":"2925114","type":"CDM"},{"code":"361","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 20.1-30-FAC","code_information":[{"code":"2925115","type":"CDM"},{"code":"361","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 30+FAC","code_information":[{"code":"2925116","type":"CDM"},{"code":"361","type":"RC"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES 10-50CM-FAC","code_information":[{"code":"2925118","type":"CDM"},{"code":"361","type":"RC"},{"code":"17107","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.75,"setting":"both","billing_class":"facility"},{"gross_charge":659.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES >50CM-FAC","code_information":[{"code":"2925119","type":"CDM"},{"code":"361","type":"RC"},{"code":"17108","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.5,"setting":"both","billing_class":"facility"},{"gross_charge":1971.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L .5CM/< -FAC","code_information":[{"code":"2925120","type":"CDM"},{"code":"361","type":"RC"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L .6-1CM -FAC","code_information":[{"code":"2925121","type":"CDM"},{"code":"361","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L 2.1-3CM-FAC","code_information":[{"code":"2925122","type":"CDM"},{"code":"361","type":"RC"},{"code":"17263","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L 3.1-4CM-FAC","code_information":[{"code":"2925123","type":"CDM"},{"code":"361","type":"RC"},{"code":"17264","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L >5CM-FAC","code_information":[{"code":"2925124","type":"CDM"},{"code":"361","type":"RC"},{"code":"17266","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"PUNCT ASP BRST ADDL-FAC","code_information":[{"code":"2925125","type":"CDM"},{"code":"361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"setting":"both","billing_class":"facility"},{"gross_charge":37.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR TUM DEEP >5CM-FAC","code_information":[{"code":"2925126","type":"CDM"},{"code":"361","type":"RC"},{"code":"23073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR LES <3CM-FAC","code_information":[{"code":"2925127","type":"CDM"},{"code":"361","type":"RC"},{"code":"23075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR TUM DEEP <5CM-FAC","code_information":[{"code":"2925128","type":"CDM"},{"code":"361","type":"RC"},{"code":"23076","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.25,"setting":"both","billing_class":"facility"},{"gross_charge":2701.25,"setting":"both","billing_class":"professional"}]},{"description":"LAVAGE BY CANNULA-FAC","code_information":[{"code":"2925129","type":"CDM"},{"code":"361","type":"RC"},{"code":"31000","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.5,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW ASPIR-FAC","code_information":[{"code":"2925130","type":"CDM"},{"code":"361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW BX-FAC","code_information":[{"code":"2925131","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW BX&ASPIR-FAC","code_information":[{"code":"2925132","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.5,"setting":"both","billing_class":"facility"},{"gross_charge":3177.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY ANAL LES-FAC","code_information":[{"code":"2925133","type":"CDM"},{"code":"361","type":"RC"},{"code":"46924","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.75,"setting":"both","billing_class":"facility"},{"gross_charge":2651.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-FAC","code_information":[{"code":"2925134","type":"CDM"},{"code":"361","type":"RC"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":3324.5,"setting":"both","billing_class":"facility"},{"gross_charge":3324.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-FAC","code_information":[{"code":"2925136","type":"CDM"},{"code":"361","type":"RC"},{"code":"52260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY CHEMODENERV-FAC","code_information":[{"code":"2925137","type":"CDM"},{"code":"361","type":"RC"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1976.5,"setting":"both","billing_class":"professional"}]},{"description":"PROSTATIC THERMOTHERAPY-FAC","code_information":[{"code":"2925138","type":"CDM"},{"code":"361","type":"RC"},{"code":"53850","type":"HCPCS"}],"standard_charges":[{"gross_charge":3324.5,"setting":"both","billing_class":"facility"},{"gross_charge":3324.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-FAC","code_information":[{"code":"2925139","type":"CDM"},{"code":"361","type":"RC"},{"code":"54065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.0,"setting":"both","billing_class":"facility"},{"gross_charge":1760.0,"setting":"both","billing_class":"professional"}]},{"description":"INJ CORPORA CAVERNOSA-FAC","code_information":[{"code":"2925140","type":"CDM"},{"code":"361","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY OF VULVA-FAC","code_information":[{"code":"2925141","type":"CDM"},{"code":"361","type":"RC"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.5,"setting":"both","billing_class":"facility"},{"gross_charge":189.5,"setting":"both","billing_class":"professional"}]},{"description":"BX VAGINAL MUCOSA-FAC","code_information":[{"code":"2925142","type":"CDM"},{"code":"361","type":"RC"},{"code":"57105","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.5,"setting":"both","billing_class":"facility"},{"gross_charge":2681.5,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINAL FB-FAC","code_information":[{"code":"2925143","type":"CDM"},{"code":"361","type":"RC"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.5,"setting":"both","billing_class":"facility"},{"gross_charge":2681.5,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF VAGINA W/SCOPE-FAC","code_information":[{"code":"2925144","type":"CDM"},{"code":"361","type":"RC"},{"code":"57420","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"facility"},{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"REM VENTIL TUBE/ANESTH-FAC","code_information":[{"code":"2925145","type":"CDM"},{"code":"361","type":"RC"},{"code":"69424","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.25,"setting":"both","billing_class":"facility"},{"gross_charge":2534.25,"setting":"both","billing_class":"professional"}]},{"description":"EKG TRACING-FAC","code_information":[{"code":"2925152","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":93.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MASTOIDS >3-FAC","code_information":[{"code":"2925156","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES <3-FAC","code_information":[{"code":"2925157","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES >3-FAC","code_information":[{"code":"2925158","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OPTIC FORAMINA-FAC","code_information":[{"code":"2925159","type":"CDM"},{"code":"320","type":"RC"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY NECK SOFT TISS-FAC","code_information":[{"code":"2925160","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY CHEST 1 VIEW-FAC","code_information":[{"code":"2925161","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY CHEST 2 VIEWS-FAC","code_information":[{"code":"2925162","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS/CHEST >3 UNIL-FAC","code_information":[{"code":"2925163","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS/CHEST >4 BILAT-FAC","code_information":[{"code":"2925164","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 1 VIEW-FAC","code_information":[{"code":"2925166","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 2 VIEWS-FAC","code_information":[{"code":"2925167","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABD COMPL ACUTE-FAC","code_information":[{"code":"2925168","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ SM JNT/BUR W/US-FAC","code_information":[{"code":"2925173","type":"CDM"},{"code":"361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.75,"setting":"both","billing_class":"facility"},{"gross_charge":281.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ INT JNT/BUR W/US-FAC","code_information":[{"code":"2925174","type":"CDM"},{"code":"361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"setting":"both","billing_class":"facility"},{"gross_charge":681.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ <2CM-FAC","code_information":[{"code":"2925175","type":"CDM"},{"code":"361","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS 3 VIEWS BILAT-FAC","code_information":[{"code":"2925176","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.25,"setting":"both","billing_class":"facility"},{"gross_charge":128.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES < 3CM-FAC","code_information":[{"code":"2925177","type":"CDM"},{"code":"361","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSE BLEED-FAC","code_information":[{"code":"2925178","type":"CDM"},{"code":"361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.25,"setting":"both","billing_class":"facility"},{"gross_charge":126.25,"setting":"both","billing_class":"professional"}]},{"description":"TANGNTL BX SKIN SINGL LES-FAC","code_information":[{"code":"2925179","type":"CDM"},{"code":"361","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"TANGNTL BX SKIN ADDL LES-FAC","code_information":[{"code":"2925180","type":"CDM"},{"code":"361","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"DECLOT VASCULAR DEVICE-FAC","code_information":[{"code":"2925188","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"setting":"both","billing_class":"facility"},{"gross_charge":328.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED SKIN PROCEDURE-FAC","code_information":[{"code":"2925189","type":"CDM"},{"code":"361","type":"RC"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"setting":"both","billing_class":"facility"},{"gross_charge":206.0,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY OF NERVE-FAC","code_information":[{"code":"2925190","type":"CDM"},{"code":"361","type":"RC"},{"code":"64795","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.25,"setting":"both","billing_class":"facility"},{"gross_charge":1851.25,"setting":"both","billing_class":"professional"}]},{"description":"SQ INJ FILLING MATERIAL-FAC","code_information":[{"code":"2925191","type":"CDM"},{"code":"361","type":"RC"},{"code":"11950","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRANIAL NRV BIL-FAC","code_information":[{"code":"2925196","type":"CDM"},{"code":"922","type":"RC"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.5,"setting":"both","billing_class":"professional"}]},{"description":"NEUROP TST BY TECH 1ST 30M-FAC","code_information":[{"code":"2925211","type":"CDM"},{"code":"918","type":"RC"},{"code":"96138","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.25,"setting":"both","billing_class":"facility"},{"gross_charge":20.25,"setting":"both","billing_class":"professional"}]},{"description":"NEUROP TST BY TECH ADD 30M-FAC","code_information":[{"code":"2925212","type":"CDM"},{"code":"918","type":"RC"},{"code":"96139","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"setting":"both","billing_class":"facility"},{"gross_charge":16.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF RADIUS-FAC","code_information":[{"code":"2925215","type":"CDM"},{"code":"361","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF ULNA W MANIP-FAC","code_information":[{"code":"2925216","type":"CDM"},{"code":"361","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED ORL SERVICE/PX-FAC","code_information":[{"code":"2925238","type":"CDM"},{"code":"470","type":"RC"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.75,"setting":"both","billing_class":"facility"},{"gross_charge":258.75,"setting":"both","billing_class":"professional"}]},{"description":"BINOCULAR VISION EXAM-FAC","code_information":[{"code":"2925239","type":"CDM"},{"code":"920","type":"RC"},{"code":"92060","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"VISUAL FIELD EXAM-FAC","code_information":[{"code":"2925240","type":"CDM"},{"code":"920","type":"RC"},{"code":"92083","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERM VISUAL FIELD EXAM-FAC","code_information":[{"code":"2925241","type":"CDM"},{"code":"920","type":"RC"},{"code":"92082","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 5-6 REGNS-FAC","code_information":[{"code":"2925251","type":"CDM"},{"code":"530","type":"RC"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 7-8 REGNS-FAC","code_information":[{"code":"2925252","type":"CDM"},{"code":"530","type":"RC"},{"code":"98928","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 9-10 REGNS-FAC","code_information":[{"code":"2925253","type":"CDM"},{"code":"530","type":"RC"},{"code":"98929","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"ASSMT & CARE PLAN-FAC","code_information":[{"code":"2925271","type":"CDM"},{"code":"510","type":"RC"},{"code":"99483","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.5,"setting":"both","billing_class":"facility"},{"gross_charge":87.5,"setting":"both","billing_class":"professional"}]},{"description":"LIMITED VISUAL EXAM-FAC","code_information":[{"code":"2925279","type":"CDM"},{"code":"920","type":"RC"},{"code":"92081","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"CORNEAL TOPOGRAPHY-FAC","code_information":[{"code":"2925280","type":"CDM"},{"code":"920","type":"RC"},{"code":"92025","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"OPHTHALMIC BIOMETRY-FAC","code_information":[{"code":"2925281","type":"CDM"},{"code":"920","type":"RC"},{"code":"92136","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM NEW PT-FAC","code_information":[{"code":"2925283","type":"CDM"},{"code":"510","type":"RC"},{"code":"92004","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM NEW PT-FAC","code_information":[{"code":"2925284","type":"CDM"},{"code":"510","type":"RC"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM & TX-FAC","code_information":[{"code":"2925285","type":"CDM"},{"code":"510","type":"RC"},{"code":"92014","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM EST PT-FAC","code_information":[{"code":"2925286","type":"CDM"},{"code":"510","type":"RC"},{"code":"92012","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION-FAC","code_information":[{"code":"2925288","type":"CDM"},{"code":"361","type":"RC"},{"code":"67801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1044.0,"setting":"both","billing_class":"facility"},{"gross_charge":1044.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION-FAC","code_information":[{"code":"2925289","type":"CDM"},{"code":"361","type":"RC"},{"code":"67805","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.75,"setting":"both","billing_class":"facility"},{"gross_charge":322.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION,SNGL-FAC","code_information":[{"code":"2925290","type":"CDM"},{"code":"361","type":"RC"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.75,"setting":"both","billing_class":"facility"},{"gross_charge":322.75,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPENING-FAC","code_information":[{"code":"2925291","type":"CDM"},{"code":"361","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.5,"setting":"both","billing_class":"facility"},{"gross_charge":396.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FB CONJUNCTIVA-FAC","code_information":[{"code":"2925292","type":"CDM"},{"code":"361","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.5,"setting":"both","billing_class":"facility"},{"gross_charge":396.5,"setting":"both","billing_class":"professional"}]},{"description":"SEVER ADHESIONS-FAC","code_information":[{"code":"2925293","type":"CDM"},{"code":"361","type":"RC"},{"code":"65860","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.25,"setting":"both","billing_class":"facility"},{"gross_charge":564.25,"setting":"both","billing_class":"professional"}]},{"description":"UNL PROC ANT EYE-FAC","code_information":[{"code":"2925294","type":"CDM"},{"code":"361","type":"RC"},{"code":"66999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2458.25,"setting":"both","billing_class":"facility"},{"gross_charge":2458.25,"setting":"both","billing_class":"professional"}]},{"description":"LASER SURGERY EYE STRNDS-FAC","code_information":[{"code":"2925295","type":"CDM"},{"code":"361","type":"RC"},{"code":"67031","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.25,"setting":"both","billing_class":"facility"},{"gross_charge":564.25,"setting":"both","billing_class":"professional"}]},{"description":"FUNDUS PHOTOGRAPHY-FAC","code_information":[{"code":"2925300","type":"CDM"},{"code":"920","type":"RC"},{"code":"92250","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX W/MAN-FAC","code_information":[{"code":"2925320","type":"CDM"},{"code":"361","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"setting":"both","billing_class":"facility"},{"gross_charge":1492.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND CORNEAL-FAC","code_information":[{"code":"2925321","type":"CDM"},{"code":"402","type":"RC"},{"code":"76514","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.25,"setting":"both","billing_class":"facility"},{"gross_charge":20.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ARM/ELBOW <3CM-FAC","code_information":[{"code":"2925322","type":"CDM"},{"code":"361","type":"RC"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.25,"setting":"both","billing_class":"facility"},{"gross_charge":1562.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPI 6/> VW-FAC/TEC","code_information":[{"code":"2925323","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.5,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY LOWER SPINE-FAC/TECH","code_information":[{"code":"2925324","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.5,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"AFTER CATARACT LASER SUR-FAC","code_information":[{"code":"2925326","type":"CDM"},{"code":"361","type":"RC"},{"code":"66821","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.75,"setting":"both","billing_class":"facility"},{"gross_charge":567.75,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF IRIS LASER-FAC","code_information":[{"code":"2925328","type":"CDM"},{"code":"361","type":"RC"},{"code":"66761","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.75,"setting":"both","billing_class":"facility"},{"gross_charge":567.75,"setting":"both","billing_class":"professional"}]},{"description":"SUBCONJUNCTIVAL INJ-FAC","code_information":[{"code":"2925329","type":"CDM"},{"code":"361","type":"RC"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"EKG INIT PREVENT TRC-FAC","code_information":[{"code":"2925330","type":"CDM"},{"code":"730","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"professional"}]},{"description":"EKG INIT PREVENT TRC-FAC","code_information":[{"code":"2925330","type":"CDM"},{"code":"730","type":"RC"},{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"setting":"both","billing_class":"facility"}]},{"description":"REM OF ANAL TAG-FAC","code_information":[{"code":"2925331","type":"CDM"},{"code":"361","type":"RC"},{"code":"46220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.25,"setting":"both","billing_class":"facility"},{"gross_charge":1124.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SACROILIAC JNTS-FAC/TECH","code_information":[{"code":"2925332","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.25,"setting":"both","billing_class":"facility"},{"gross_charge":126.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CLOSE TEAR DUCT OPENING-FAC","code_information":[{"code":"2925333","type":"CDM"},{"code":"361","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  OCCIP-FAC","code_information":[{"code":"2925334","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"facility"},{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 2 LIMBS-FAC","code_information":[{"code":"2925335","type":"CDM"},{"code":"922","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 3 LIMBS-FAC","code_information":[{"code":"2925336","type":"CDM"},{"code":"922","type":"RC"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 4 LIMBS-FAC","code_information":[{"code":"2925337","type":"CDM"},{"code":"922","type":"RC"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.75,"setting":"both","billing_class":"facility"},{"gross_charge":156.75,"setting":"both","billing_class":"professional"}]},{"description":"SLIT LAMP PHOTO-FAC","code_information":[{"code":"2925342","type":"CDM"},{"code":"922","type":"RC"},{"code":"92285","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX <=50SQ CM-FAC","code_information":[{"code":"2925343","type":"CDM"},{"code":"922","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.5,"setting":"both","billing_class":"facility"},{"gross_charge":358.5,"setting":"both","billing_class":"professional"}]},{"description":"TRABECULOPLASTY LASER SURG-FAC","code_information":[{"code":"2925345","type":"CDM"},{"code":"361","type":"RC"},{"code":"65855","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.75,"setting":"both","billing_class":"facility"},{"gross_charge":567.75,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHOGR INJ-FAC","code_information":[{"code":"2925346","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHROGR INJ-FAC","code_information":[{"code":"2925347","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.25,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR C/T INJ-FAC","code_information":[{"code":"2925348","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"setting":"both","billing_class":"facility"},{"gross_charge":700.0,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR L/S INJ-FAC","code_information":[{"code":"2925349","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"setting":"both","billing_class":"facility"},{"gross_charge":700.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ-FAC","code_information":[{"code":"2925350","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"setting":"both","billing_class":"facility"},{"gross_charge":700.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ SNGL LVL-FAC","code_information":[{"code":"2925351","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"setting":"both","billing_class":"facility"},{"gross_charge":700.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ EA ADDL LVL-FAC","code_information":[{"code":"2925352","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER II/IH NRV INJ-FAC","code_information":[{"code":"2925353","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"setting":"both","billing_class":"facility"},{"gross_charge":700.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IMG INJ-FAC","code_information":[{"code":"2925354","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IM ADD LVL-FAC","code_information":[{"code":"2925355","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.75,"setting":"both","billing_class":"facility"},{"gross_charge":75.75,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S SNGL LVL-FAC","code_information":[{"code":"2925356","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S EA ADDL LVL-FAC","code_information":[{"code":"2925357","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.25,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 1 LVL-FAC","code_information":[{"code":"2925358","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.75,"setting":"both","billing_class":"facility"},{"gross_charge":937.75,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 2 LVL-FAC","code_information":[{"code":"2925359","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 3 LVL-FAC","code_information":[{"code":"2925360","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 1 LVL-FAC","code_information":[{"code":"2925361","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.75,"setting":"both","billing_class":"facility"},{"gross_charge":959.75,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 2 LVL-FAC","code_information":[{"code":"2925362","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 3 LVL-FAC","code_information":[{"code":"2925363","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES SPHEN GANGL INJ-FAC","code_information":[{"code":"2925364","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.5,"setting":"both","billing_class":"facility"},{"gross_charge":293.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES STELL GANGL INJ-FAC","code_information":[{"code":"2925365","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"NB HYPOGAS PLXS INJ-FAC","code_information":[{"code":"2925366","type":"CDM"},{"code":"361","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES LMBR/THRC INJ-FAC","code_information":[{"code":"2925367","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES CELIAC PLXS INJ-FAC","code_information":[{"code":"2925368","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"setting":"both","billing_class":"facility"},{"gross_charge":909.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT-FAC","code_information":[{"code":"2925369","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"setting":"both","billing_class":"facility"},{"gross_charge":1924.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT ADDL-FAC","code_information":[{"code":"2925370","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.5,"setting":"both","billing_class":"facility"},{"gross_charge":91.5,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT-FAC","code_information":[{"code":"2925371","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"setting":"both","billing_class":"facility"},{"gross_charge":1924.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT ADDL-FAC","code_information":[{"code":"2925372","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.75,"setting":"both","billing_class":"facility"},{"gross_charge":72.75,"setting":"both","billing_class":"professional"}]},{"description":"BLINKI REFLEX TST-FAC","code_information":[{"code":"2925374","type":"CDM"},{"code":"920","type":"RC"},{"code":"95933","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/O PR-FAC","code_information":[{"code":"2925377","type":"CDM"},{"code":"920","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/ PR-FAC","code_information":[{"code":"2925378","type":"CDM"},{"code":"920","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.25,"setting":"both","billing_class":"facility"},{"gross_charge":41.25,"setting":"both","billing_class":"professional"}]},{"description":"ALYS NEUROST COMPL W/ PR-FAC","code_information":[{"code":"2925379","type":"CDM"},{"code":"920","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.25,"setting":"both","billing_class":"facility"},{"gross_charge":127.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EAR WAX-FAC","code_information":[{"code":"2925380","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC CYST/GANGLION TOES-FAC","code_information":[{"code":"2925381","type":"CDM"},{"code":"361","type":"RC"},{"code":"28092","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.25,"setting":"both","billing_class":"facility"},{"gross_charge":1517.25,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL NEW E/M SF 15MIN-FAC","code_information":[{"code":"2925392","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL NEW E/M LOW 30MIN-FAC","code_information":[{"code":"2925393","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL EST E/M LEV 1-FAC","code_information":[{"code":"2925394","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL EST E/M SF 10MIN-FAC","code_information":[{"code":"2925395","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL EST E/M LOW 20MIN-FAC","code_information":[{"code":"2925396","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL EST E/M MOD 30MIN-FAC","code_information":[{"code":"2925397","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL EST E/M HIGH 40MIN-FAC","code_information":[{"code":"2925398","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE NEW E/M SF 15MIN-FAC","code_information":[{"code":"2925409","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE NEW E/M LOW 30MIN-FAC","code_information":[{"code":"2925410","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE NEW E/M MOD 45MIN-FAC","code_information":[{"code":"2925411","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE NEW E/M HIGH 60MIN-FAC","code_information":[{"code":"2925412","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE EST E/M LEV 1-FAC","code_information":[{"code":"2925413","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE EST E/M SF 10MIN-FAC","code_information":[{"code":"2925414","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE EST E/M LOW 20MIN-FAC","code_information":[{"code":"2925415","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE EST E/M MOD 30MIN-FAC","code_information":[{"code":"2925416","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE EST E/M HIGH 40MIN-FAC","code_information":[{"code":"2925417","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL NEW E/M MOD 45MIN-FAC","code_information":[{"code":"2925419","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"LACRIMAL PUNCTA SNIP-FAC","code_information":[{"code":"2925428","type":"CDM"},{"code":"361","type":"RC"},{"code":"68440","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"facility"},{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"OPSCPY EXT W/ SCL DEP-FAC","code_information":[{"code":"2925429","type":"CDM"},{"code":"510","type":"RC"},{"code":"92201","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL PREV NEW INFANT-FAC","code_information":[{"code":"2925430","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 1-4YR-FAC","code_information":[{"code":"2925431","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 5-11YR-FAC","code_information":[{"code":"2925432","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 12-17YR-FAC","code_information":[{"code":"2925433","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 18-39YR-FAC","code_information":[{"code":"2925434","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 40-64YR-FAC","code_information":[{"code":"2925435","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV NEW 65FAC","code_information":[{"code":"2925436","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST INFANT-FAC","code_information":[{"code":"2925437","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 1-4YR-FAC","code_information":[{"code":"2925438","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 5-11YR-FAC","code_information":[{"code":"2925439","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 12-17YR-FAC","code_information":[{"code":"2925440","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 18-39YR-FAC","code_information":[{"code":"2925441","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 40-64YR-FAC","code_information":[{"code":"2925442","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL PREV EST 65FAC","code_information":[{"code":"2925443","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"BX SOFT TISSUE THIGH/KNEE-FAC","code_information":[{"code":"2925451","type":"CDM"},{"code":"361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"setting":"both","billing_class":"facility"},{"gross_charge":1536.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL NEW E/M HIGH 60MIN-FAC","code_information":[{"code":"2925454","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"},{"gross_charge":132.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"POSITIONAL NYSTAGMUS TST-FAC","code_information":[{"code":"2925460","type":"CDM"},{"code":"470","type":"RC"},{"code":"92542","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/O STIM 15M-FAC","code_information":[{"code":"2925464","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97810","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/O STIM ADDL 15M-FAC","code_information":[{"code":"2925465","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97811","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.5,"setting":"both","billing_class":"facility"},{"gross_charge":5.5,"setting":"both","billing_class":"professional"}]},{"description":"A-SCAN EYE US W IOL MEASR-FAC","code_information":[{"code":"2925466","type":"CDM"},{"code":"402","type":"RC"},{"code":"76519","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.25,"setting":"both","billing_class":"facility"},{"gross_charge":126.25,"setting":"both","billing_class":"professional"}]},{"description":"OPSCPY EXT W/O SCL DEP-FAC","code_information":[{"code":"2925467","type":"CDM"},{"code":"510","type":"RC"},{"code":"92202","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP NO REPROGRAM-FAC","code_information":[{"code":"2925468","type":"CDM"},{"code":"361","type":"RC"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REPROGRAM-FAC","code_information":[{"code":"2925469","type":"CDM"},{"code":"361","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL/REPRO-FAC","code_information":[{"code":"2925470","type":"CDM"},{"code":"361","type":"RC"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL-FAC","code_information":[{"code":"2925471","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.5,"setting":"both","billing_class":"facility"},{"gross_charge":293.5,"setting":"both","billing_class":"professional"}]},{"description":"CORNEA SCRAPING SMEAR/CUL-FAC","code_information":[{"code":"2925472","type":"CDM"},{"code":"361","type":"RC"},{"code":"65430","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ TRIGEMINAL BIL-FAC","code_information":[{"code":"2925473","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"N BLOCK OTH PERIPHERAL BIL-FAC","code_information":[{"code":"2925474","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1021.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"AMNIOTIC GRAFT-FAC","code_information":[{"code":"2925475","type":"CDM"},{"code":"361","type":"RC"},{"code":"65778","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.75,"setting":"both","billing_class":"facility"},{"gross_charge":903.75,"setting":"both","billing_class":"professional"}]},{"description":"PARACENTESIS ANT CHAMB-FAC","code_information":[{"code":"2925476","type":"CDM"},{"code":"361","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.25,"setting":"both","billing_class":"facility"},{"gross_charge":2262.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UPPER LID-FAC","code_information":[{"code":"2925477","type":"CDM"},{"code":"361","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.75,"setting":"both","billing_class":"facility"},{"gross_charge":1815.75,"setting":"both","billing_class":"professional"}]},{"description":"REM CORNEAL EPI-FAC","code_information":[{"code":"2925478","type":"CDM"},{"code":"361","type":"RC"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.75,"setting":"both","billing_class":"facility"},{"gross_charge":903.75,"setting":"both","billing_class":"professional"}]},{"description":"EPILATION,FORCEPS-FAC","code_information":[{"code":"2925479","type":"CDM"},{"code":"361","type":"RC"},{"code":"67820","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":123.25,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LESION-FAC","code_information":[{"code":"2925482","type":"CDM"},{"code":"361","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.5,"setting":"both","billing_class":"facility"},{"gross_charge":1041.5,"setting":"both","billing_class":"professional"}]},{"description":"TENON CAPSULE INJ-FAC","code_information":[{"code":"2925483","type":"CDM"},{"code":"361","type":"RC"},{"code":"67515","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"facility"},{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"HARVEST CULTURED SK GRAFT-FAC","code_information":[{"code":"2925490","type":"CDM"},{"code":"361","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.75,"setting":"both","billing_class":"facility"},{"gross_charge":1815.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA BIL-FAC","code_information":[{"code":"2925491","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPAIR ENTROPION SUTURE-FAC","code_information":[{"code":"2925492","type":"CDM"},{"code":"361","type":"RC"},{"code":"67921","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY PALATE UVULA-FAC","code_information":[{"code":"2925493","type":"CDM"},{"code":"361","type":"RC"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.75,"setting":"both","billing_class":"facility"},{"gross_charge":1509.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HORMONE SQ-FAC","code_information":[{"code":"2925495","type":"CDM"},{"code":"361","type":"RC"},{"code":"11980","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"setting":"both","billing_class":"facility"},{"gross_charge":408.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR EXTENSIVE ECTROPIAN-FAC","code_information":[{"code":"2925496","type":"CDM"},{"code":"361","type":"RC"},{"code":"67917","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF PELVIS 3V-FAC/TECH","code_information":[{"code":"2925497","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"INC CONJUNCTIVA DRAINAGE-FAC","code_information":[{"code":"2925498","type":"CDM"},{"code":"361","type":"RC"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.75,"setting":"both","billing_class":"facility"},{"gross_charge":903.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSC-FAC","code_information":[{"code":"2925499","type":"CDM"},{"code":"361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"setting":"both","billing_class":"facility"},{"gross_charge":1536.0,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE OF BLADDER TUBE-FAC","code_information":[{"code":"2925500","type":"CDM"},{"code":"361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.25,"setting":"both","billing_class":"facility"},{"gross_charge":623.25,"setting":"both","billing_class":"professional"}]},{"description":"ANES VIA SPHENO CATH-FAC","code_information":[{"code":"2925504","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.5,"setting":"both","billing_class":"facility"},{"gross_charge":293.5,"setting":"both","billing_class":"professional"}]},{"description":"PERC RELEASE DUPUYTREN CON-FAC","code_information":[{"code":"2925515","type":"CDM"},{"code":"361","type":"RC"},{"code":"26040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.25,"setting":"both","billing_class":"facility"},{"gross_charge":1517.25,"setting":"both","billing_class":"professional"}]},{"description":"ALYS IMPLANT W/PRGRM-FAC","code_information":[{"code":"2925519","type":"CDM"},{"code":"922","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.25,"setting":"both","billing_class":"facility"},{"gross_charge":127.25,"setting":"both","billing_class":"professional"}]},{"description":"ALYS CPLX IMPLANT W/PRGRM-FAC","code_information":[{"code":"2925520","type":"CDM"},{"code":"922","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.25,"setting":"both","billing_class":"facility"},{"gross_charge":127.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV TRUNK MUSC 1-5-FAC","code_information":[{"code":"2925523","type":"CDM"},{"code":"361","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"setting":"both","billing_class":"facility"},{"gross_charge":701.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM HIP-FAC","code_information":[{"code":"2925524","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.75,"setting":"both","billing_class":"facility"},{"gross_charge":427.75,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-FAC","code_information":[{"code":"2925525","type":"CDM"},{"code":"361","type":"RC"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-FAC","code_information":[{"code":"2925526","type":"CDM"},{"code":"361","type":"RC"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ENTROPION THERMOCAU-FAC","code_information":[{"code":"2925527","type":"CDM"},{"code":"361","type":"RC"},{"code":"67922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.5,"setting":"both","billing_class":"facility"},{"gross_charge":2165.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM BIL HIP-FAC","code_information":[{"code":"2925528","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":855.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXPL/TX RADIOCARPAL JNT-FAC","code_information":[{"code":"2925613","type":"CDM"},{"code":"361","type":"RC"},{"code":"25040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3062.75,"setting":"both","billing_class":"facility"},{"gross_charge":3062.75,"setting":"both","billing_class":"professional"}]},{"description":"AEP SCR AUDITORY POTENL-FAC","code_information":[{"code":"2926008","type":"CDM"},{"code":"470","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.5,"setting":"both","billing_class":"facility"},{"gross_charge":161.5,"setting":"both","billing_class":"professional"}]},{"description":"AEP HEARING STATUS DET I&R-FAC","code_information":[{"code":"2926009","type":"CDM"},{"code":"470","type":"RC"},{"code":"92651","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"setting":"both","billing_class":"facility"},{"gross_charge":323.0,"setting":"both","billing_class":"professional"}]},{"description":"AEP THRSHLD EST ML FRQ I&R-FAC","code_information":[{"code":"2926010","type":"CDM"},{"code":"470","type":"RC"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"setting":"both","billing_class":"facility"},{"gross_charge":306.0,"setting":"both","billing_class":"professional"}]},{"description":"AEP NEURODIAGNOSTIC I&R-FAC","code_information":[{"code":"2926011","type":"CDM"},{"code":"470","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"facility"},{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE MGNT 1ST 20M-FAC","code_information":[{"code":"2926013","type":"CDM"},{"code":"470","type":"RC"},{"code":"99490","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.25,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE EA ADDL 20M-FAC","code_information":[{"code":"2926014","type":"CDM"},{"code":"470","type":"RC"},{"code":"99439","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.25,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"ADVANCED DIRECTIVE GUIDNCE-FAC","code_information":[{"code":"2926015","type":"CDM"},{"code":"470","type":"RC"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.25,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"NB FEMORAL BIL-FAC","code_information":[{"code":"2926016","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1166.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1166.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-FAC","code_information":[{"code":"2926017","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":777.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-FAC","code_information":[{"code":"2926018","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":777.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY LOWER LEG BIL-FAC/TECH","code_information":[{"code":"2926019","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY ANKLE BILATERAL-FAC/TECH","code_information":[{"code":"2926020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":227.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPAIR ENTROPION EXTENSIVE-FAC","code_information":[{"code":"2926022","type":"CDM"},{"code":"361","type":"RC"},{"code":"67924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.5,"setting":"both","billing_class":"facility"},{"gross_charge":1583.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FOOT BILATERAL-FAC/TECH","code_information":[{"code":"2926023","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY OF FOOT BIL-FAC/TECH","code_information":[{"code":"2926024","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":143.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HLTH BHV ASSMT/REASST-FAC","code_information":[{"code":"2926026","type":"CDM"},{"code":"918","type":"RC"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.75,"setting":"both","billing_class":"facility"},{"gross_charge":89.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV INVT J IND 1ST 30-FAC","code_information":[{"code":"2926027","type":"CDM"},{"code":"918","type":"RC"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.75,"setting":"both","billing_class":"facility"},{"gross_charge":89.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT INDIV EA ADD-FAC","code_information":[{"code":"2926028","type":"CDM"},{"code":"918","type":"RC"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.75,"setting":"both","billing_class":"facility"},{"gross_charge":21.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FAM 1ST 30-FAC","code_information":[{"code":"2926029","type":"CDM"},{"code":"918","type":"RC"},{"code":"96167","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNTJ FAM EA ADDL-FAC","code_information":[{"code":"2926030","type":"CDM"},{"code":"918","type":"RC"},{"code":"96168","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.25,"setting":"both","billing_class":"facility"},{"gross_charge":23.25,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM WO PT 1ST-FAC","code_information":[{"code":"2926031","type":"CDM"},{"code":"918","type":"RC"},{"code":"96170","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.25,"setting":"both","billing_class":"facility"},{"gross_charge":21.25,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM W/O PT EA-FAC","code_information":[{"code":"2926032","type":"CDM"},{"code":"918","type":"RC"},{"code":"96171","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.25,"setting":"both","billing_class":"facility"},{"gross_charge":21.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ JNT/BURSA BIL-FAC","code_information":[{"code":"2926033","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":533.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"THER INJ CARP TUNNEL BIL-FAC","code_information":[{"code":"2926034","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":533.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTO W FRAGM OF CALCULUS-FAC","code_information":[{"code":"2926035","type":"CDM"},{"code":"361","type":"RC"},{"code":"52325","type":"HCPCS"}],"standard_charges":[{"gross_charge":4956.25,"setting":"both","billing_class":"facility"},{"gross_charge":4956.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENT SPINE 4/5 VW-FAC/TECH","code_information":[{"code":"2926036","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.75,"setting":"both","billing_class":"facility"},{"gross_charge":122.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHEMODEN MUSC NECK BIL-FAC","code_information":[{"code":"2926037","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":440.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY EXAM SPINE 1 VW-FAC/TECH","code_information":[{"code":"2926038","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"NJX INTERLAMINAR LMBR/SAC-FAC","code_information":[{"code":"2926599","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"setting":"both","billing_class":"facility"},{"gross_charge":713.0,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEX DRAINAGE WND-FAC","code_information":[{"code":"2927001","type":"CDM"},{"code":"361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2661.5,"setting":"both","billing_class":"facility"},{"gross_charge":2661.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE MUSC-FAC","code_information":[{"code":"2927002","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE 20CM OR LESS-FAC","code_information":[{"code":"2927003","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1652.75,"setting":"both","billing_class":"facility"},{"gross_charge":1652.75,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN SINGLE LES-FAC","code_information":[{"code":"2927006","type":"CDM"},{"code":"361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 1.1-5.0CC-FAC","code_information":[{"code":"2927011","type":"CDM"},{"code":"361","type":"RC"},{"code":"11951","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 5.1-10.0 CC-FAC","code_information":[{"code":"2927012","type":"CDM"},{"code":"361","type":"RC"},{"code":"11952","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP ADDL 100 CM-FAC","code_information":[{"code":"2927014","type":"CDM"},{"code":"361","type":"RC"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"setting":"both","billing_class":"facility"},{"gross_charge":418.0,"setting":"both","billing_class":"professional"}]},{"description":"WND F/N/HF/G 100 SQCM/1%BA-FAC","code_information":[{"code":"2927015","type":"CDM"},{"code":"361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.75,"setting":"both","billing_class":"facility"},{"gross_charge":659.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX OPEN SUPERFICIAL-FAC","code_information":[{"code":"2927016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2661.5,"setting":"both","billing_class":"facility"},{"gross_charge":2661.5,"setting":"both","billing_class":"professional"}]},{"description":"I & D INFECTED BURSA  FOOT-FAC","code_information":[{"code":"2927018","type":"CDM"},{"code":"361","type":"RC"},{"code":"28001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.5,"setting":"both","billing_class":"facility"},{"gross_charge":1580.5,"setting":"both","billing_class":"professional"}]},{"description":"DEEP DIS FT INF SGL BURSA-FAC","code_information":[{"code":"2927019","type":"CDM"},{"code":"361","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.75,"setting":"both","billing_class":"facility"},{"gross_charge":1563.75,"setting":"both","billing_class":"professional"}]},{"description":"DEEP I&D FT INF MULTI AREA-FAC","code_information":[{"code":"2927020","type":"CDM"},{"code":"361","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"DEEP INC FT W OP BONE CRTX-FAC","code_information":[{"code":"2927021","type":"CDM"},{"code":"361","type":"RC"},{"code":"28005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISE FOOT/TOE FASCIA-FAC","code_information":[{"code":"2927022","type":"CDM"},{"code":"361","type":"RC"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY SQ TOE; SINGLE-FAC","code_information":[{"code":"2927023","type":"CDM"},{"code":"361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.75,"setting":"both","billing_class":"facility"},{"gross_charge":1564.75,"setting":"both","billing_class":"professional"}]},{"description":"REM DEEP FB OF FOOT-FAC","code_information":[{"code":"2927024","type":"CDM"},{"code":"361","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.5,"setting":"both","billing_class":"facility"},{"gross_charge":1580.5,"setting":"both","billing_class":"professional"}]},{"description":"TENTMY OP FLEX FT SGL/MULT-FAC","code_information":[{"code":"2927025","type":"CDM"},{"code":"361","type":"RC"},{"code":"28230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.75,"setting":"both","billing_class":"facility"},{"gross_charge":1563.75,"setting":"both","billing_class":"professional"}]},{"description":"MTP JNT CAPSULO EA SGL JNT-FAC","code_information":[{"code":"2927026","type":"CDM"},{"code":"361","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION HALLUX VALGUS-FAC","code_information":[{"code":"2927027","type":"CDM"},{"code":"361","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"CL TX MTP JNT DISLC W ANES-FAC","code_information":[{"code":"2927028","type":"CDM"},{"code":"361","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.75,"setting":"both","billing_class":"facility"},{"gross_charge":1563.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JNT DISLC WO ANES-FAC","code_information":[{"code":"2927029","type":"CDM"},{"code":"361","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.75,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JOINT DISL W ANES-FAC","code_information":[{"code":"2927030","type":"CDM"},{"code":"361","type":"RC"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.25,"setting":"both","billing_class":"facility"},{"gross_charge":271.25,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING OF TOES-FAC","code_information":[{"code":"2927031","type":"CDM"},{"code":"361","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.75,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ COMMON DIGIT-FAC","code_information":[{"code":"2927032","type":"CDM"},{"code":"361","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.75,"setting":"both","billing_class":"facility"},{"gross_charge":293.75,"setting":"both","billing_class":"professional"}]},{"description":"DECOM PLANTAR DIGITAL NERV-FAC","code_information":[{"code":"2927034","type":"CDM"},{"code":"361","type":"RC"},{"code":"64726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1970.0,"setting":"both","billing_class":"facility"},{"gross_charge":1970.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND LMT JT-FAC","code_information":[{"code":"2927035","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.75,"setting":"both","billing_class":"facility"}]},{"description":"INC MULTI SQ TOE TENDONS-FAC","code_information":[{"code":"2927042","type":"CDM"},{"code":"361","type":"RC"},{"code":"28011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1705.75,"setting":"both","billing_class":"facility"},{"gross_charge":1705.75,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY NAIL UNIT-FAC","code_information":[{"code":"2927045","type":"CDM"},{"code":"361","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"setting":"both","billing_class":"facility"},{"gross_charge":699.0,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 1.1-2.5 CM-FAC","code_information":[{"code":"2927046","type":"CDM"},{"code":"361","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L ADDL 5CM/<-FAC","code_information":[{"code":"2927047","type":"CDM"},{"code":"361","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","billing_class":"facility"},{"gross_charge":142.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN PINCH GRAFT-FAC","code_information":[{"code":"2927048","type":"CDM"},{"code":"361","type":"RC"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-FAC","code_information":[{"code":"2927049","type":"CDM"},{"code":"361","type":"RC"},{"code":"15241","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.25,"setting":"both","billing_class":"facility"},{"gross_charge":267.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-FAC","code_information":[{"code":"2927050","type":"CDM"},{"code":"361","type":"RC"},{"code":"15261","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.5,"setting":"both","billing_class":"facility"},{"gross_charge":183.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTOF SKIN LESIONS-FAC","code_information":[{"code":"2927051","type":"CDM"},{"code":"361","type":"RC"},{"code":"17270","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"S/N/H/F/G LES DIAM>4.0 CM-FAC","code_information":[{"code":"2927052","type":"CDM"},{"code":"361","type":"RC"},{"code":"17276","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE H/N/HF/G-FAC","code_information":[{"code":"2927053","type":"CDM"},{"code":"361","type":"RC"},{"code":"17311","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE-FAC","code_information":[{"code":"2927054","type":"CDM"},{"code":"361","type":"RC"},{"code":"17312","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.5,"setting":"both","billing_class":"facility"},{"gross_charge":195.5,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE T/A/L-FAC","code_information":[{"code":"2927055","type":"CDM"},{"code":"361","type":"RC"},{"code":"17313","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE T/A/L-FAC","code_information":[{"code":"2927056","type":"CDM"},{"code":"361","type":"RC"},{"code":"17314","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.5,"setting":"both","billing_class":"facility"},{"gross_charge":181.5,"setting":"both","billing_class":"professional"}]},{"description":"MOHS SURG ADDL BLOCK-FAC","code_information":[{"code":"2927057","type":"CDM"},{"code":"361","type":"RC"},{"code":"17315","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE EACH ADD-FAC","code_information":[{"code":"2927139","type":"CDM"},{"code":"361","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"setting":"both","billing_class":"facility"},{"gross_charge":357.5,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 1.1-2.5 CM-FAC","code_information":[{"code":"2927140","type":"CDM"},{"code":"361","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 2.6-7.5 CM-FAC","code_information":[{"code":"2927141","type":"CDM"},{"code":"361","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK EA ADDL 5CM/<-FAC","code_information":[{"code":"2927142","type":"CDM"},{"code":"361","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.25,"setting":"both","billing_class":"facility"},{"gross_charge":231.25,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 1.1-2.5 CM-FAC","code_information":[{"code":"2927143","type":"CDM"},{"code":"361","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 2.6-7.5 CM-FAC","code_information":[{"code":"2927144","type":"CDM"},{"code":"361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG EA ADL 5 CM<-FAC","code_information":[{"code":"2927145","type":"CDM"},{"code":"361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.5,"setting":"both","billing_class":"facility"},{"gross_charge":252.5,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F1.1-2.5CM-FAC","code_information":[{"code":"2927146","type":"CDM"},{"code":"361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F2.6-7.5CM-FAC","code_information":[{"code":"2927147","type":"CDM"},{"code":"361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F DADL5CM<-FAC","code_information":[{"code":"2927148","type":"CDM"},{"code":"361","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.5,"setting":"both","billing_class":"facility"},{"gross_charge":335.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 2.6-7.5 CM-FAC","code_information":[{"code":"2927150","type":"CDM"},{"code":"361","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<-FAC","code_information":[{"code":"2927151","type":"CDM"},{"code":"361","type":"RC"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TRNK 10.1-30SQCM-FAC","code_information":[{"code":"2927152","type":"CDM"},{"code":"361","type":"RC"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<-FAC","code_information":[{"code":"2927153","type":"CDM"},{"code":"361","type":"RC"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L10.1-30SQCM-FAC","code_information":[{"code":"2927154","type":"CDM"},{"code":"361","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F 10SQCM/<-FAC","code_information":[{"code":"2927155","type":"CDM"},{"code":"361","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F10.1-30-FAC","code_information":[{"code":"2927156","type":"CDM"},{"code":"361","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR E/N/E/L 10 SQCM<-FAC","code_information":[{"code":"2927157","type":"CDM"},{"code":"361","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"TRNFR E/N/E/L10.1-30SQCM-FAC","code_information":[{"code":"2927158","type":"CDM"},{"code":"361","type":"RC"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F 20 CM/<-FAC","code_information":[{"code":"2927159","type":"CDM"},{"code":"361","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT EEN & LIPS-FAC","code_information":[{"code":"2927160","type":"CDM"},{"code":"361","type":"RC"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.25,"setting":"both","billing_class":"facility"},{"gross_charge":1926.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SK LES-FAC","code_information":[{"code":"2927161","type":"CDM"},{"code":"361","type":"RC"},{"code":"17271","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-FAC","code_information":[{"code":"2927162","type":"CDM"},{"code":"361","type":"RC"},{"code":"17272","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":183.5,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 2.1-3.0CM-FAC","code_information":[{"code":"2927163","type":"CDM"},{"code":"361","type":"RC"},{"code":"17273","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.5,"setting":"both","billing_class":"facility"},{"gross_charge":183.5,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 3.1-4.0CM-FAC","code_information":[{"code":"2927164","type":"CDM"},{"code":"361","type":"RC"},{"code":"17274","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP TRK/ARM/LEG-FAC","code_information":[{"code":"2927165","type":"CDM"},{"code":"361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1978.75,"setting":"both","billing_class":"facility"},{"gross_charge":1978.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-FAC","code_information":[{"code":"2927166","type":"CDM"},{"code":"361","type":"RC"},{"code":"17280","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 1.1-2.0CM-FAC","code_information":[{"code":"2927167","type":"CDM"},{"code":"361","type":"RC"},{"code":"17282","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":353.25,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 2.1-3.0CM-FAC","code_information":[{"code":"2927168","type":"CDM"},{"code":"361","type":"RC"},{"code":"17283","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO INTRALESIONL UP TO 7-FAC","code_information":[{"code":"2927169","type":"CDM"},{"code":"331","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"setting":"both","billing_class":"facility"},{"gross_charge":70.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-CERVICAL-FAC","code_information":[{"code":"2927170","type":"CDM"},{"code":"361","type":"RC"},{"code":"58321","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.5,"setting":"both","billing_class":"facility"},{"gross_charge":316.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-UTERINE-FAC","code_information":[{"code":"2927171","type":"CDM"},{"code":"361","type":"RC"},{"code":"58322","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"setting":"both","billing_class":"facility"},{"gross_charge":191.75,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ANY 30.1-60 SQ CM-FA","code_information":[{"code":"2927172","type":"CDM"},{"code":"361","type":"RC"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":3955.0,"setting":"both","billing_class":"facility"},{"gross_charge":3955.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ADDL 30 SQ CM-FAC","code_information":[{"code":"2927173","type":"CDM"},{"code":"361","type":"RC"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","billing_class":"facility"},{"gross_charge":416.25,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP F/N/HF/G ADDL CM-FAC","code_information":[{"code":"2927174","type":"CDM"},{"code":"361","type":"RC"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"setting":"both","billing_class":"facility"},{"gross_charge":418.0,"setting":"both","billing_class":"professional"}]},{"description":"MAL LESF/E/E/N/L/M 3.1-4.0-FAC","code_information":[{"code":"2927175","type":"CDM"},{"code":"361","type":"RC"},{"code":"17284","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"MAL LESF/E/E/N/L/M >4.0 CM-FAC","code_information":[{"code":"2927176","type":"CDM"},{"code":"361","type":"RC"},{"code":"17286","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV ECCRINE GLANDS-FAC","code_information":[{"code":"2927179","type":"CDM"},{"code":"361","type":"RC"},{"code":"64650","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.75,"setting":"both","billing_class":"facility"},{"gross_charge":293.75,"setting":"both","billing_class":"professional"}]},{"description":"CHMODNERV ECRINE GLAND OTH-FAC","code_information":[{"code":"2927180","type":"CDM"},{"code":"361","type":"RC"},{"code":"64653","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.75,"setting":"both","billing_class":"facility"},{"gross_charge":293.75,"setting":"both","billing_class":"professional"}]},{"description":"ELEC CURRENT THERAPY EA 15-FAC","code_information":[{"code":"2927182","type":"CDM"},{"code":"940","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.5,"setting":"both","billing_class":"facility"},{"gross_charge":26.5,"setting":"both","billing_class":"professional"}]},{"description":"TX CONTOUR DEFECTS>10.0 CC-FAC","code_information":[{"code":"2927183","type":"CDM"},{"code":"361","type":"RC"},{"code":"11954","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"facility"},{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FOOT COMP-FAC","code_information":[{"code":"2927184","type":"CDM"},{"code":"361","type":"RC"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.25,"setting":"both","billing_class":"facility"},{"gross_charge":1580.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF TOE DISLOCATION-FAC","code_information":[{"code":"2927187","type":"CDM"},{"code":"361","type":"RC"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.25,"setting":"both","billing_class":"facility"},{"gross_charge":3178.25,"setting":"both","billing_class":"professional"}]},{"description":"TRIMMING NAILS-FAC","code_information":[{"code":"2927188","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING UNNA BOOT BIL-FAC","code_information":[{"code":"2927189","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":238.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN OUTER EAR CANAL LESN-FAC","code_information":[{"code":"2927191","type":"CDM"},{"code":"361","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"setting":"both","billing_class":"facility"},{"gross_charge":699.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE/DRAIN TEAR SAC-FAC","code_information":[{"code":"2927192","type":"CDM"},{"code":"361","type":"RC"},{"code":"68420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2248.5,"setting":"both","billing_class":"facility"},{"gross_charge":2248.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY THORACIC SPINE 4/>VW-FAC","code_information":[{"code":"2927194","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"facility"},{"gross_charge":133.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"INJ TENDON SHEATH/LIG BIL-FAC","code_information":[{"code":"2927195","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":422.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DSTRJ NULYT AGT GNCLR NRV-FAC","code_information":[{"code":"2927196","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1970.0,"setting":"both","billing_class":"facility"},{"gross_charge":1970.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF URETHRA INJURY-FAC","code_information":[{"code":"2927197","type":"CDM"},{"code":"361","type":"RC"},{"code":"53502","type":"HCPCS"}],"standard_charges":[{"gross_charge":3454.75,"setting":"both","billing_class":"facility"},{"gross_charge":3454.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-MYOMECTOMY COMPLEX-FAC","code_information":[{"code":"2927198","type":"CDM"},{"code":"361","type":"RC"},{"code":"58546","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"setting":"both","billing_class":"facility"},{"gross_charge":10002.0,"setting":"both","billing_class":"professional"}]},{"description":"ENDOCERV CURETTAGE W/SCOPE-FAC","code_information":[{"code":"2927199","type":"CDM"},{"code":"361","type":"RC"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.5,"setting":"both","billing_class":"facility"},{"gross_charge":316.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST CMPLT BIL-FAC/TECH","code_information":[{"code":"2927200","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":140.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSED TX VERT FX W/MANJ-FAC","code_information":[{"code":"2927201","type":"CDM"},{"code":"361","type":"RC"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.75,"setting":"both","billing_class":"facility"},{"gross_charge":3177.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL INTRANASAL LES INT-FAC","code_information":[{"code":"2927204","type":"CDM"},{"code":"361","type":"RC"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":3073.25,"setting":"both","billing_class":"facility"},{"gross_charge":3073.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL INTRANASAL LES EXT-FAC","code_information":[{"code":"2927205","type":"CDM"},{"code":"361","type":"RC"},{"code":"30118","type":"HCPCS"}],"standard_charges":[{"gross_charge":3073.25,"setting":"both","billing_class":"facility"},{"gross_charge":3073.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY SALPINGOSTOMY-FAC","code_information":[{"code":"2927208","type":"CDM"},{"code":"361","type":"RC"},{"code":"58673","type":"HCPCS"}],"standard_charges":[{"gross_charge":5681.75,"setting":"both","billing_class":"facility"},{"gross_charge":5681.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE SHOULDER FORGN BODY-FAC","code_information":[{"code":"2927209","type":"CDM"},{"code":"361","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"setting":"both","billing_class":"facility"},{"gross_charge":699.0,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JNT/BURSA BIL W/US-FAC","code_information":[{"code":"2927210","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":457.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAPARO PROC ABDM/PER/OMENT-FAC","code_information":[{"code":"2927211","type":"CDM"},{"code":"361","type":"RC"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":5166.0,"setting":"both","billing_class":"facility"},{"gross_charge":5166.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF HAND BIL-FAC/TECH","code_information":[{"code":"2927216","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":140.5,"setting":"both","modifiers":"TC|50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier 50: Bilateral Procedure"}]},{"description":"TREATMENT OF MOUTH LESION-FAC","code_information":[{"code":"2927222","type":"CDM"},{"code":"361","type":"RC"},{"code":"40820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3122.5,"setting":"both","billing_class":"facility"},{"gross_charge":3122.5,"setting":"both","billing_class":"professional"}]},{"description":"INJECTION TREATMENT OF EYE-FAC","code_information":[{"code":"2927224","type":"CDM"},{"code":"361","type":"RC"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2370.5,"setting":"both","billing_class":"facility"},{"gross_charge":2370.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF TOE TENDON-FAC","code_information":[{"code":"2927226","type":"CDM"},{"code":"361","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.75,"setting":"both","billing_class":"facility"},{"gross_charge":683.75,"setting":"both","billing_class":"professional"}]},{"description":"PRQ IMPLTJ NEUROSTIMULATOR-FAC","code_information":[{"code":"2927237","type":"CDM"},{"code":"361","type":"RC"},{"code":"64555","type":"HCPCS"}],"standard_charges":[{"gross_charge":7035.5,"setting":"both","billing_class":"facility"},{"gross_charge":7035.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE FACE MC BIL-FAC","code_information":[{"code":"2927239","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":448.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 4 MORE BIL-FAC/TECH","code_information":[{"code":"2927240","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":195.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXHALED NITRIC OXIDE MEAS-FAC","code_information":[{"code":"2927241","type":"CDM"},{"code":"361","type":"RC"},{"code":"95012","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION OF ASTIGMATISM-FAC","code_information":[{"code":"2927256","type":"CDM"},{"code":"361","type":"RC"},{"code":"65772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.75,"setting":"both","billing_class":"facility"},{"gross_charge":1008.75,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ NEUROLYTIC AGENT NRV-FAC","code_information":[{"code":"2927257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"setting":"both","billing_class":"facility"},{"gross_charge":940.0,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 14 DAY DIS-FAC","code_information":[{"code":"2927258","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.5,"setting":"both","billing_class":"facility"},{"gross_charge":148.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 7 DAY DIS-FAC","code_information":[{"code":"2927259","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.25,"setting":"both","billing_class":"facility"},{"gross_charge":323.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY RIGID LEG CAST-FAC","code_information":[{"code":"2927262","type":"CDM"},{"code":"361","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.75,"setting":"both","billing_class":"facility"},{"gross_charge":276.75,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS W/IMAGING-FAC","code_information":[{"code":"2927263","type":"CDM"},{"code":"402","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.25,"setting":"both","billing_class":"facility"},{"gross_charge":1301.25,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS WO/IMAGING-FAC","code_information":[{"code":"2927264","type":"CDM"},{"code":"402","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.25,"setting":"both","billing_class":"facility"},{"gross_charge":1301.25,"setting":"both","billing_class":"professional"}]},{"description":"INSRT DRUG DEVICE-FAC","code_information":[{"code":"2927272","type":"CDM"},{"code":"361","type":"RC"},{"code":"68841","type":"HCPCS"}],"standard_charges":[{"gross_charge":2330.5,"setting":"both","billing_class":"facility"},{"gross_charge":2330.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL SUTURE OR STAPLE-FAC","code_information":[{"code":"2927275","type":"CDM"},{"code":"361","type":"RC"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.75,"setting":"both","billing_class":"facility"},{"gross_charge":10.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL SUTURE AND STAPLE-FAC","code_information":[{"code":"2927276","type":"CDM"},{"code":"361","type":"RC"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"setting":"both","billing_class":"facility"},{"gross_charge":14.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM ANKLE LT-FAC","code_information":[{"code":"2927277","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":406.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM ANKLE RT-FAC","code_information":[{"code":"2927278","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":406.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FNA W/O IMAGE-PBB","code_information":[{"code":"2930010","type":"CDM"},{"code":"361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SKIN ABSCESS-PBB","code_information":[{"code":"2930014","type":"CDM"},{"code":"361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY;SIMPLE-PBB","code_information":[{"code":"2930015","type":"CDM"},{"code":"361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"ACNE SURGERY-PBB","code_information":[{"code":"2930016","type":"CDM"},{"code":"361","type":"RC"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PILONIDAL CYST;SIMPL-PBB","code_information":[{"code":"2930017","type":"CDM"},{"code":"361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY;COMPLEX-PBB","code_information":[{"code":"2930018","type":"CDM"},{"code":"361","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SKIN ABSCESS-PBB","code_information":[{"code":"2930019","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN PILONIDAL CYST;COMP-PBB","code_information":[{"code":"2930028","type":"CDM"},{"code":"361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE HEMATOMA/FLUID-PBB","code_information":[{"code":"2930037","type":"CDM"},{"code":"361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE DRAINAGE OF LES-PBB","code_information":[{"code":"2930040","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE INFECTED SKIN-PBB","code_information":[{"code":"2930043","type":"CDM"},{"code":"361","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SKIN/TISSUE-PBB","code_information":[{"code":"2930046","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"DEB SUBQ TISSUE ADD-ON-PBB","code_information":[{"code":"2930055","type":"CDM"},{"code":"361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESION-PBB","code_information":[{"code":"2930058","type":"CDM"},{"code":"361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.5,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESIONS  2 TO 4-PBB","code_information":[{"code":"2930061","type":"CDM"},{"code":"361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"setting":"both","billing_class":"professional"}]},{"description":"TRIM SKIN LESIONS  OVER 4-PBB","code_information":[{"code":"2930064","type":"CDM"},{"code":"361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SKIN TAGS-PBB","code_information":[{"code":"2930073","type":"CDM"},{"code":"361","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"REM SKIN TAGS ADD-ON-PBB","code_information":[{"code":"2930076","type":"CDM"},{"code":"361","type":"RC"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930079","type":"CDM"},{"code":"361","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930082","type":"CDM"},{"code":"361","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.5,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930085","type":"CDM"},{"code":"361","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930088","type":"CDM"},{"code":"361","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930091","type":"CDM"},{"code":"361","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930094","type":"CDM"},{"code":"361","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930097","type":"CDM"},{"code":"361","type":"RC"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930100","type":"CDM"},{"code":"361","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930103","type":"CDM"},{"code":"361","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE SKIN LESION-PBB","code_information":[{"code":"2930106","type":"CDM"},{"code":"361","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 0.5 < CM-PBB","code_information":[{"code":"2930109","type":"CDM"},{"code":"361","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 0.6-1 CM-PBB","code_information":[{"code":"2930112","type":"CDM"},{"code":"361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 1.1-2 CM-PBB","code_information":[{"code":"2930115","type":"CDM"},{"code":"361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 2.1-3 CM-PBB","code_information":[{"code":"2930118","type":"CDM"},{"code":"361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 3.1-4 CM-PBB","code_information":[{"code":"2930121","type":"CDM"},{"code":"361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT B9 > 4.0 CM-PBB","code_information":[{"code":"2930124","type":"CDM"},{"code":"361","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H-F-NK-SP B9 0.5 <-PBB","code_information":[{"code":"2930127","type":"CDM"},{"code":"361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"EX H-F-NK-SP B9 0.6-1-PBB","code_information":[{"code":"2930130","type":"CDM"},{"code":"361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H-F-NK-SP B9 1.1-2-PBB","code_information":[{"code":"2930133","type":"CDM"},{"code":"361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H-F-NK-SP B9 2.1-3-PBB","code_information":[{"code":"2930136","type":"CDM"},{"code":"361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H-F-NK-SP B9 3.1-4-PBB","code_information":[{"code":"2930139","type":"CDM"},{"code":"361","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM B9 0.5 <CM-PBB","code_information":[{"code":"2930142","type":"CDM"},{"code":"361","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM B9 0.6-1CM-PBB","code_information":[{"code":"2930145","type":"CDM"},{"code":"361","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM B9 1.1-2CM-PBB","code_information":[{"code":"2930148","type":"CDM"},{"code":"361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM B9 2.1-3CM-PBB","code_information":[{"code":"2930151","type":"CDM"},{"code":"361","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM B9 3.1-4CM-PBB","code_information":[{"code":"2930154","type":"CDM"},{"code":"361","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EX MLG 0.5 <CM-PBB","code_information":[{"code":"2930157","type":"CDM"},{"code":"361","type":"RC"},{"code":"11600","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EX MLG 0.6-1CM-PBB","code_information":[{"code":"2930160","type":"CDM"},{"code":"361","type":"RC"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EX MLG 1.1-2CM-PBB","code_information":[{"code":"2930163","type":"CDM"},{"code":"361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EX MLG 2.1-3CM-PBB","code_information":[{"code":"2930166","type":"CDM"},{"code":"361","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.5,"setting":"both","billing_class":"professional"}]},{"description":"EX TR/EX MLG 3.1-4CM-PBB","code_information":[{"code":"2930169","type":"CDM"},{"code":"361","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TR-EXT MLG > 4 CM-PBB","code_information":[{"code":"2930172","type":"CDM"},{"code":"361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC H/F/NK/SP MAL .5<-PBB","code_information":[{"code":"2930174","type":"CDM"},{"code":"361","type":"RC"},{"code":"11620","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/NK/S MLG 0.6-1-PBB","code_information":[{"code":"2930175","type":"CDM"},{"code":"361","type":"RC"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/NK/S MLG 1.1-2-PBB","code_information":[{"code":"2930178","type":"CDM"},{"code":"361","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC S/N/H/F/G MLG 2.1-3-PBB","code_information":[{"code":"2930179","type":"CDM"},{"code":"361","type":"RC"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC S/N/H/F/G MAL 3.1-4-PBB","code_information":[{"code":"2930180","type":"CDM"},{"code":"361","type":"RC"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.5,"setting":"both","billing_class":"professional"}]},{"description":"EX H/F/NK/S MLG> 4CM-PBB","code_information":[{"code":"2930181","type":"CDM"},{"code":"361","type":"RC"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM MALIG 0.6-1-PBB","code_information":[{"code":"2930184","type":"CDM"},{"code":"361","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM MALIG 1.1-2-PBB","code_information":[{"code":"2930187","type":"CDM"},{"code":"361","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.25,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM MALIG 2.1-3-PBB","code_information":[{"code":"2930190","type":"CDM"},{"code":"361","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"setting":"both","billing_class":"professional"}]},{"description":"EX FC/MM MALIG 3.1-4-PBB","code_information":[{"code":"2930193","type":"CDM"},{"code":"361","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.75,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE-MM MLG > 4 CM-PBB","code_information":[{"code":"2930196","type":"CDM"},{"code":"361","type":"RC"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.5,"setting":"both","billing_class":"professional"}]},{"description":"TRIM NAIL-PBB","code_information":[{"code":"2930199","type":"CDM"},{"code":"361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE NAIL  1-5-PBB","code_information":[{"code":"2930202","type":"CDM"},{"code":"361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE NAIL  6 OR MORE-PBB","code_information":[{"code":"2930205","type":"CDM"},{"code":"361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NAIL PLATE-PBB","code_information":[{"code":"2930208","type":"CDM"},{"code":"361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"REM NAIL PLATE  ADD-ON-PBB","code_information":[{"code":"2930211","type":"CDM"},{"code":"361","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN BL FROM UNDER NAIL-PBB","code_information":[{"code":"2930214","type":"CDM"},{"code":"361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NAIL BED-PBB","code_information":[{"code":"2930217","type":"CDM"},{"code":"361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.5,"setting":"both","billing_class":"professional"}]},{"description":"EX OF NAIL FOLD  TOE-PBB","code_information":[{"code":"2930220","type":"CDM"},{"code":"361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ INTO SKIN LESIONS-PBB","code_information":[{"code":"2930223","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF CONTRACEPTIVE CAP-PBB","code_information":[{"code":"2930226","type":"CDM"},{"code":"361","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT DRUG IMPLANT DEV-PBB","code_information":[{"code":"2930229","type":"CDM"},{"code":"361","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"REM DRUG IMPLANT DEVICE-PBB","code_information":[{"code":"2930232","type":"CDM"},{"code":"361","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"REM/INSERT DRUG IMPLANT-PBB","code_information":[{"code":"2930235","type":"CDM"},{"code":"361","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-PBB","code_information":[{"code":"2930238","type":"CDM"},{"code":"361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-PBB","code_information":[{"code":"2930241","type":"CDM"},{"code":"361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-PBB","code_information":[{"code":"2930244","type":"CDM"},{"code":"361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-PBB","code_information":[{"code":"2930247","type":"CDM"},{"code":"361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR SUPERFICIAL WOUND-PBB","code_information":[{"code":"2930250","type":"CDM"},{"code":"361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"CLOSURE OF SPLIT WOUND-PBB","code_information":[{"code":"2930253","type":"CDM"},{"code":"361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.5,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.5CM/<-PBB","code_information":[{"code":"2930259","type":"CDM"},{"code":"361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-PBB","code_information":[{"code":"2930262","type":"CDM"},{"code":"361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 7.6-12.5CM-PBB","code_information":[{"code":"2930265","type":"CDM"},{"code":"361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND 2.6-7.5CM-PBB","code_information":[{"code":"2930268","type":"CDM"},{"code":"361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.75,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND FACE 2.5CM/<-PBB","code_information":[{"code":"2930271","type":"CDM"},{"code":"361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"professional"}]},{"description":"INTMD RPR WND FACE 2.6-5CM-PBB","code_information":[{"code":"2930274","type":"CDM"},{"code":"361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR TRNK/ARM/LEG-PBB","code_information":[{"code":"2930277","type":"CDM"},{"code":"361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.75,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR T/A/L ADD-ON-PBB","code_information":[{"code":"2930280","type":"CDM"},{"code":"361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR FACE/NK/HF/G-PBB","code_information":[{"code":"2930283","type":"CDM"},{"code":"361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN SUB GR F/N/HF/G ADDL-PBB","code_information":[{"code":"2930286","type":"CDM"},{"code":"361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.5,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL TREAT OF BURN-PBB","code_information":[{"code":"2930289","type":"CDM"},{"code":"361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"DRESS/DEBRID P/THCK BURN-PBB","code_information":[{"code":"2930292","type":"CDM"},{"code":"361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"setting":"both","billing_class":"professional"}]},{"description":"DRESS/DEBRID P/THCK BURN-PBB","code_information":[{"code":"2930295","type":"CDM"},{"code":"361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"DRESS/DEBRID P/THCK BURN-PBB","code_information":[{"code":"2930298","type":"CDM"},{"code":"361","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY BENIGN/PREMLG LES-PBB","code_information":[{"code":"2930302","type":"CDM"},{"code":"361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY LESIONS  2-14-PBB","code_information":[{"code":"2930305","type":"CDM"},{"code":"361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY LESIONS  15&>-PBB","code_information":[{"code":"2930308","type":"CDM"},{"code":"361","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT OF SKIN LESIONS-PBB","code_information":[{"code":"2930311","type":"CDM"},{"code":"361","type":"RC"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT LESION  1-14-PBB","code_information":[{"code":"2930314","type":"CDM"},{"code":"361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY LESIONS  15&>-PBB","code_information":[{"code":"2930317","type":"CDM"},{"code":"361","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL CAUTERY  TISSUE-PBB","code_information":[{"code":"2930320","type":"CDM"},{"code":"361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT OF SKIN LESIONS-PBB","code_information":[{"code":"2930323","type":"CDM"},{"code":"361","type":"RC"},{"code":"17262","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT OF SKIN LESIONS-PBB","code_information":[{"code":"2930326","type":"CDM"},{"code":"361","type":"RC"},{"code":"17281","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.25,"setting":"both","billing_class":"professional"}]},{"description":"CRYOTHERAPY OF SKIN-PBB","code_information":[{"code":"2930329","type":"CDM"},{"code":"361","type":"RC"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF BREAST LESION-PBB","code_information":[{"code":"2930332","type":"CDM"},{"code":"361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST 1ST LES US IMAG-PBB","code_information":[{"code":"2930335","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.75,"setting":"both","billing_class":"professional"}]},{"description":"BX BRST PERCUT W/O IMAGE-PBB","code_information":[{"code":"2930338","type":"CDM"},{"code":"361","type":"RC"},{"code":"19100","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF BREAST  OPEN-PBB","code_information":[{"code":"2930341","type":"CDM"},{"code":"361","type":"RC"},{"code":"19101","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF BREAST LESION-PBB","code_information":[{"code":"2930344","type":"CDM"},{"code":"361","type":"RC"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY COMPRS LWR LEG BIL-PBB","code_information":[{"code":"2930501","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"RPR NSL VLV CLPSE W/RMDL-PBB","code_information":[{"code":"2930504","type":"CDM"},{"code":"361","type":"RC"},{"code":"30469","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER 2 VIEW LT-PBB","code_information":[{"code":"2930505","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY ELBOW 3 VIEW LT-PBB","code_information":[{"code":"2930506","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY WRIST 3 VIEW LT-PBB","code_information":[{"code":"2930507","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.25,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HAND 3 VIEW LT-PBB","code_information":[{"code":"2930508","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.25,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY HIP 2-3 VIEW LT-PBB","code_information":[{"code":"2930509","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NEUROMUSCULAR JUNCTION TST-PBB","code_information":[{"code":"2930510","type":"CDM"},{"code":"510","type":"RC"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.75,"setting":"both","billing_class":"professional"}]},{"description":"PSYCHOPHYSIOLOGICAL THERAP-PBB","code_information":[{"code":"2930512","type":"CDM"},{"code":"510","type":"RC"},{"code":"90875","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC NEUROFIBROM CUT NRV-PBB","code_information":[{"code":"2930513","type":"CDM"},{"code":"510","type":"RC"},{"code":"64788","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC TUMOR ABD LES SC 3CM/>-PBB","code_information":[{"code":"2930514","type":"CDM"},{"code":"510","type":"RC"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"setting":"both","billing_class":"professional"}]},{"description":"SPINE SINGLE VIEW-PBB","code_information":[{"code":"2930515","type":"CDM"},{"code":"510","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"OB US DETAILED SNGL FETUS-PBB","code_information":[{"code":"2930516","type":"CDM"},{"code":"510","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"OB US BIOPH PROF W/NST-PBB","code_information":[{"code":"2930517","type":"CDM"},{"code":"510","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/STIM 15MIN-PBB","code_information":[{"code":"2930518","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97813","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.25,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/STIM ADDL 15MIN-PBB","code_information":[{"code":"2930519","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97814","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYTX COMPLEX INTERACTIVE-PBB","code_information":[{"code":"2930520","type":"CDM"},{"code":"510","type":"RC"},{"code":"90785","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.75,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JNT/BRSA WO US BIL-PBB","code_information":[{"code":"2930521","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTOSCOPY REMOVAL/CLOTS-PBB","code_information":[{"code":"2930522","type":"CDM"},{"code":"361","type":"RC"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF FORGEIN BODY-PBB","code_information":[{"code":"2930523","type":"CDM"},{"code":"361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPCT WAX W/TOOL BIL-PBB","code_information":[{"code":"2930524","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EX ARM/ELBW TUM DEEP 5CM/>-PBB","code_information":[{"code":"2930525","type":"CDM"},{"code":"361","type":"RC"},{"code":"24073","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.5,"setting":"both","billing_class":"professional"}]},{"description":"EX ARM/ELBOW TUM DEEP <5CM-PBB","code_information":[{"code":"2930526","type":"CDM"},{"code":"361","type":"RC"},{"code":"24076","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOREARM TUM DEEP 3CM/>-PBB","code_information":[{"code":"2930527","type":"CDM"},{"code":"361","type":"RC"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOREARM TUM DEEP <3CM-PBB","code_information":[{"code":"2930528","type":"CDM"},{"code":"361","type":"RC"},{"code":"25076","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV TUM DEEP 5CM/>PBB","code_information":[{"code":"2930529","type":"CDM"},{"code":"361","type":"RC"},{"code":"27045","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV LES SC < 3CM-PBB","code_information":[{"code":"2930530","type":"CDM"},{"code":"361","type":"RC"},{"code":"27047","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC HIP/PELV TUM DEEP <5CM-PBB","code_information":[{"code":"2930531","type":"CDM"},{"code":"361","type":"RC"},{"code":"27048","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC THGH/KNEE TUM DEP <5CM-PBB","code_information":[{"code":"2930532","type":"CDM"},{"code":"361","type":"RC"},{"code":"27328","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC THGH/KNEE TUM DEP 5CM/>PBB","code_information":[{"code":"2930533","type":"CDM"},{"code":"361","type":"RC"},{"code":"27339","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM < 3CM-PBB","code_information":[{"code":"2930534","type":"CDM"},{"code":"361","type":"RC"},{"code":"27618","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM DEP <5CM-PBB","code_information":[{"code":"2930535","type":"CDM"},{"code":"361","type":"RC"},{"code":"27619","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE LES SC 3CM/>-PBB","code_information":[{"code":"2930536","type":"CDM"},{"code":"361","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC LEG/ANKLE TUM DEP 5CM/>PBB","code_information":[{"code":"2930537","type":"CDM"},{"code":"361","type":"RC"},{"code":"27634","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM SC 1.5CM/>PBB","code_information":[{"code":"2930538","type":"CDM"},{"code":"361","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC FT/TOE TUM DEP 1.5CM/>PBB","code_information":[{"code":"2930539","type":"CDM"},{"code":"361","type":"RC"},{"code":"28041","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM SC <1.5CM-PBB","code_information":[{"code":"2930540","type":"CDM"},{"code":"361","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC FOOT/TOE TUM DEP<1.5CM-PBB","code_information":[{"code":"2930541","type":"CDM"},{"code":"361","type":"RC"},{"code":"28045","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC FACE TUM DEEP 2 CM/>-PBB","code_information":[{"code":"2930542","type":"CDM"},{"code":"361","type":"RC"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC NECK TUM DEEP 5CM/>-PBB","code_information":[{"code":"2930543","type":"CDM"},{"code":"361","type":"RC"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC NECK TUM DEEP < 5CM-PBB","code_information":[{"code":"2930544","type":"CDM"},{"code":"361","type":"RC"},{"code":"21556","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC BACK TUM DEEP 5CM/>-PBB","code_information":[{"code":"2930545","type":"CDM"},{"code":"361","type":"RC"},{"code":"21933","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP < 5CM-PBB","code_information":[{"code":"2930546","type":"CDM"},{"code":"361","type":"RC"},{"code":"22900","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABDL TUM DEEP 5CM/>-PBB","code_information":[{"code":"2930547","type":"CDM"},{"code":"361","type":"RC"},{"code":"22901","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC ABD LES SC < 3CM-PBB","code_information":[{"code":"2930548","type":"CDM"},{"code":"361","type":"RC"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE LUNG CATHETER-PBB","code_information":[{"code":"2930549","type":"CDM"},{"code":"361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.5,"setting":"both","billing_class":"professional"}]},{"description":"EXCISION OF PENIS LESION-PBB","code_information":[{"code":"2930550","type":"CDM"},{"code":"361","type":"RC"},{"code":"54060","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"setting":"both","billing_class":"professional"}]},{"description":"TX OF MISCARRIAGE-PBB","code_information":[{"code":"2930551","type":"CDM"},{"code":"361","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.75,"setting":"both","billing_class":"professional"}]},{"description":"CLN OUT MASTOID CAVITY BIL-PBB","code_information":[{"code":"2930552","type":"CDM"},{"code":"361","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"RECONSTRUCT EXTRA FINGER-PBB","code_information":[{"code":"2930554","type":"CDM"},{"code":"361","type":"RC"},{"code":"26587","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMICAL PEEL NONFACIAL-PBB","code_information":[{"code":"2930555","type":"CDM"},{"code":"361","type":"RC"},{"code":"15792","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.75,"setting":"both","billing_class":"professional"}]},{"description":"N BLCK INJ PLNTR DIGIT BIL-PBB","code_information":[{"code":"2930556","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CHEMICAL PEEL FACE EPIDERM-PBB","code_information":[{"code":"2930557","type":"CDM"},{"code":"361","type":"RC"},{"code":"15788","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.75,"setting":"both","billing_class":"professional"}]},{"description":"FILLETED FINGER/TOE FLAP-PBB","code_information":[{"code":"2930558","type":"CDM"},{"code":"361","type":"RC"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.5,"setting":"both","billing_class":"professional"}]},{"description":"TREATMENT OF ANKLE FX-PBB","code_information":[{"code":"2930560","type":"CDM"},{"code":"361","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE BENDING-PBB","code_information":[{"code":"2930561","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY THORACIC SPINE 3V-PBB","code_information":[{"code":"2930562","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 15M-PBB","code_information":[{"code":"2930563","type":"CDM"},{"code":"510","type":"RC"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 30M-PBB","code_information":[{"code":"2930564","type":"CDM"},{"code":"510","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 45M-PBB","code_information":[{"code":"2930565","type":"CDM"},{"code":"510","type":"RC"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV MED CNSL INDIV 1HR-PBB","code_information":[{"code":"2930566","type":"CDM"},{"code":"510","type":"RC"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.75,"setting":"both","billing_class":"professional"}]},{"description":"REM WAX W/AUDIO TEST-PBB","code_information":[{"code":"2930567","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0268","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.75,"setting":"both","billing_class":"professional"}]},{"description":"THER INJ  CARP TUNNEL-PBB","code_information":[{"code":"2930600","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON SHEATH/LIG-PBB","code_information":[{"code":"2930603","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON ORIGIN/INSERT-PBB","code_information":[{"code":"2930606","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT  1/2-PBB","code_information":[{"code":"2930609","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT  =/> 3-PBB","code_information":[{"code":"2930612","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT  JOINT/BURSA-PBB","code_information":[{"code":"2930615","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT  JOINT/BURSA-PBB","code_information":[{"code":"2930618","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JOINT/BURSA-PBB","code_information":[{"code":"2930621","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ JNT/BURSA W/US-PBB","code_information":[{"code":"2930624","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"professional"}]},{"description":"ASP/INJ GANGLION CYST-PBB","code_information":[{"code":"2930627","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF IMPLANT SUPERFICIAL-PBB","code_information":[{"code":"2930630","type":"CDM"},{"code":"361","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ >2CM-PBB","code_information":[{"code":"2930633","type":"CDM"},{"code":"361","type":"RC"},{"code":"21012","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.5,"setting":"both","billing_class":"professional"}]},{"description":"EX FACE TUM DEEP < 2 CM-PBB","code_information":[{"code":"2930636","type":"CDM"},{"code":"361","type":"RC"},{"code":"21013","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN NECK/CHEST LESION-PBB","code_information":[{"code":"2930642","type":"CDM"},{"code":"361","type":"RC"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"setting":"both","billing_class":"professional"}]},{"description":"EX LES NCK/CHST SQ >3CM-PBB","code_information":[{"code":"2930645","type":"CDM"},{"code":"361","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"setting":"both","billing_class":"professional"}]},{"description":"REM LES NCK/CHST SQ<3CM-PBB","code_information":[{"code":"2930648","type":"CDM"},{"code":"361","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT STERNUM FX-PBB","code_information":[{"code":"2930651","type":"CDM"},{"code":"361","type":"RC"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"REM LES BACK/FLANK <3CM-PBB","code_information":[{"code":"2930654","type":"CDM"},{"code":"361","type":"RC"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.5,"setting":"both","billing_class":"professional"}]},{"description":"REM LES BACK/FLANK >3CM-PBB","code_information":[{"code":"2930657","type":"CDM"},{"code":"361","type":"RC"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"setting":"both","billing_class":"professional"}]},{"description":"EX BACK TUM DEEP < 5 CM-PBB","code_information":[{"code":"2930660","type":"CDM"},{"code":"361","type":"RC"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SPINE FX-PBB","code_information":[{"code":"2930663","type":"CDM"},{"code":"361","type":"RC"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"REM SHOULDER LES >3CM-PBB","code_information":[{"code":"2930666","type":"CDM"},{"code":"361","type":"RC"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT CLAVICLE FX-PBB","code_information":[{"code":"2930669","type":"CDM"},{"code":"361","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT CLAVICLE DISLOC-PBB","code_information":[{"code":"2930672","type":"CDM"},{"code":"361","type":"RC"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SHOULDER BLADE FX-PBB","code_information":[{"code":"2930675","type":"CDM"},{"code":"361","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930678","type":"CDM"},{"code":"361","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930681","type":"CDM"},{"code":"361","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SHOULDER DISLOC-PBB","code_information":[{"code":"2930684","type":"CDM"},{"code":"361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.5,"setting":"both","billing_class":"professional"}]},{"description":"REM ARM/ELBOW LES > 3CM-PBB","code_information":[{"code":"2930687","type":"CDM"},{"code":"361","type":"RC"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930690","type":"CDM"},{"code":"361","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930693","type":"CDM"},{"code":"361","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930696","type":"CDM"},{"code":"361","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX-PBB","code_information":[{"code":"2930699","type":"CDM"},{"code":"361","type":"RC"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ELBOW DISLOCATION-PBB","code_information":[{"code":"2930702","type":"CDM"},{"code":"361","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT RADIUS FX-PBB","code_information":[{"code":"2930705","type":"CDM"},{"code":"361","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ULNAR FX-PBB","code_information":[{"code":"2930708","type":"CDM"},{"code":"361","type":"RC"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM LES SUBC>3CM-PBB","code_information":[{"code":"2930711","type":"CDM"},{"code":"361","type":"RC"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.25,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREARM LES SUBC<3CM-PBB","code_information":[{"code":"2930714","type":"CDM"},{"code":"361","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF RADIUS-PBB","code_information":[{"code":"2930717","type":"CDM"},{"code":"361","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF ULNA-PBB","code_information":[{"code":"2930720","type":"CDM"},{"code":"361","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX RADIUS & ULNA-PBB","code_information":[{"code":"2930723","type":"CDM"},{"code":"361","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX RADIUS & ULNA-PBB","code_information":[{"code":"2930726","type":"CDM"},{"code":"361","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX RADIUS/ULNA-PBB","code_information":[{"code":"2930729","type":"CDM"},{"code":"361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX RADIUS/ULNA-PBB","code_information":[{"code":"2930732","type":"CDM"},{"code":"361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-PBB","code_information":[{"code":"2930735","type":"CDM"},{"code":"361","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-PBB","code_information":[{"code":"2930738","type":"CDM"},{"code":"361","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT WRIST BONE FX-PBB","code_information":[{"code":"2930741","type":"CDM"},{"code":"361","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF FINGER ABSC-PBB","code_information":[{"code":"2930744","type":"CDM"},{"code":"361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METACARPAL FX-PBB","code_information":[{"code":"2930747","type":"CDM"},{"code":"361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METACARPAL FX-PBB","code_information":[{"code":"2930750","type":"CDM"},{"code":"361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX  EACH-PBB","code_information":[{"code":"2930753","type":"CDM"},{"code":"361","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX  EACH-PBB","code_information":[{"code":"2930756","type":"CDM"},{"code":"361","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX  EACH-PBB","code_information":[{"code":"2930759","type":"CDM"},{"code":"361","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER FX  EACH-PBB","code_information":[{"code":"2930762","type":"CDM"},{"code":"361","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FINGER DISLOCATION-PBB","code_information":[{"code":"2930765","type":"CDM"},{"code":"361","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.5,"setting":"both","billing_class":"professional"}]},{"description":"EX HIP PELV LES SC >3CM-PBB","code_information":[{"code":"2930768","type":"CDM"},{"code":"361","type":"RC"},{"code":"27043","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.75,"setting":"both","billing_class":"professional"}]},{"description":"CLSD TX PELVIC RING FX-PBB","code_information":[{"code":"2930771","type":"CDM"},{"code":"361","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TAIL BONE FX-PBB","code_information":[{"code":"2930774","type":"CDM"},{"code":"361","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HIP SOCKET FX-PBB","code_information":[{"code":"2930777","type":"CDM"},{"code":"361","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-PBB","code_information":[{"code":"2930780","type":"CDM"},{"code":"361","type":"RC"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT THIGH FX-PBB","code_information":[{"code":"2930783","type":"CDM"},{"code":"361","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HIP DISLOCATION-PBB","code_information":[{"code":"2930786","type":"CDM"},{"code":"361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"setting":"both","billing_class":"professional"}]},{"description":"CL TX OF THIGH FX-PBB","code_information":[{"code":"2930789","type":"CDM"},{"code":"361","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES > 3 CM-PBB","code_information":[{"code":"2930792","type":"CDM"},{"code":"361","type":"RC"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF THIGH FX-PBB","code_information":[{"code":"2930795","type":"CDM"},{"code":"361","type":"RC"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF THIGH FX-PBB","code_information":[{"code":"2930798","type":"CDM"},{"code":"361","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":839.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF THIGH FX-PBB","code_information":[{"code":"2930801","type":"CDM"},{"code":"361","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF THIGH FX-PBB","code_information":[{"code":"2930804","type":"CDM"},{"code":"361","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1177.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT KNEECAP FX-PBB","code_information":[{"code":"2930807","type":"CDM"},{"code":"361","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT KNEE FX-PBB","code_information":[{"code":"2930810","type":"CDM"},{"code":"361","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT KNEE FX-PBB","code_information":[{"code":"2930813","type":"CDM"},{"code":"361","type":"RC"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF TIBIA FX-PBB","code_information":[{"code":"2930816","type":"CDM"},{"code":"361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF ANKLE FX-PBB","code_information":[{"code":"2930819","type":"CDM"},{"code":"361","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"professional"}]},{"description":"CLTX POST ANKLE FX-PBB","code_information":[{"code":"2930822","type":"CDM"},{"code":"361","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF FIBULA FX-PBB","code_information":[{"code":"2930825","type":"CDM"},{"code":"361","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF ANKLE FX-PBB","code_information":[{"code":"2930828","type":"CDM"},{"code":"361","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF ANKLE FX-PBB","code_information":[{"code":"2930831","type":"CDM"},{"code":"361","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF ANKLE FX-PBB","code_information":[{"code":"2930834","type":"CDM"},{"code":"361","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT LOWER LEG FX-PBB","code_information":[{"code":"2930837","type":"CDM"},{"code":"361","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF FOOT FOREIGN BODY-PBB","code_information":[{"code":"2930840","type":"CDM"},{"code":"361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF HEEL FX-PBB","code_information":[{"code":"2930843","type":"CDM"},{"code":"361","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF ANKLE FX-PBB","code_information":[{"code":"2930846","type":"CDM"},{"code":"361","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT MIDFOOT FX  EACH-PBB","code_information":[{"code":"2930849","type":"CDM"},{"code":"361","type":"RC"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT METATARSAL FX-PBB","code_information":[{"code":"2930852","type":"CDM"},{"code":"361","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT BIG TOE FX-PBB","code_information":[{"code":"2930855","type":"CDM"},{"code":"361","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF TOE FX-PBB","code_information":[{"code":"2930858","type":"CDM"},{"code":"361","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF TOE FX-PBB","code_information":[{"code":"2930861","type":"CDM"},{"code":"361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT SESAMOID BONE FX-PBB","code_information":[{"code":"2930864","type":"CDM"},{"code":"361","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT TOE DISLOCATION-PBB","code_information":[{"code":"2930867","type":"CDM"},{"code":"361","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF LONG ARM CAST-PBB","code_information":[{"code":"2930870","type":"CDM"},{"code":"361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF FOREARM CAST-PBB","code_information":[{"code":"2930873","type":"CDM"},{"code":"361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY HAND/WRIST CAST-PBB","code_information":[{"code":"2930876","type":"CDM"},{"code":"361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LONG ARM SPLINT-PBB","code_information":[{"code":"2930879","type":"CDM"},{"code":"361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY FOREARM SPLINT-PBB","code_information":[{"code":"2930882","type":"CDM"},{"code":"361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF FINGER SPLINT-PBB","code_information":[{"code":"2930885","type":"CDM"},{"code":"361","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF LONG LEG CAST-PBB","code_information":[{"code":"2930889","type":"CDM"},{"code":"361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF LONG LEG CAST-PBB","code_information":[{"code":"2930892","type":"CDM"},{"code":"361","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PBB","code_information":[{"code":"2930895","type":"CDM"},{"code":"361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PBB","code_information":[{"code":"2930898","type":"CDM"},{"code":"361","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY SHORT LEG CAST-PBB","code_information":[{"code":"2930901","type":"CDM"},{"code":"361","type":"RC"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY  LONG LEG SPLINT-PBB","code_information":[{"code":"2930904","type":"CDM"},{"code":"361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"APPLY LOWER LEG SPLINT-PBB","code_information":[{"code":"2930907","type":"CDM"},{"code":"361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING OF ANKLE/FT-PBB","code_information":[{"code":"2930910","type":"CDM"},{"code":"361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","billing_class":"professional"}]},{"description":"APPLY OF PASTE BOOT-PBB","code_information":[{"code":"2930913","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY COMPRS LWR LEG-PBB","code_information":[{"code":"2930916","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVISION OF CAST-PBB","code_information":[{"code":"2930919","type":"CDM"},{"code":"361","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"REM/REVISION OF CAST-PBB","code_information":[{"code":"2930922","type":"CDM"},{"code":"361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"WINDOWING OF CAST-PBB","code_information":[{"code":"2930925","type":"CDM"},{"code":"361","type":"RC"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"WEDGING OF CAST-PBB","code_information":[{"code":"2930928","type":"CDM"},{"code":"361","type":"RC"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"professional"}]},{"description":"CASTING/STRAPPING-PBB","code_information":[{"code":"2930931","type":"CDM"},{"code":"361","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"INTRANASAL BX-PBB","code_information":[{"code":"2931200","type":"CDM"},{"code":"361","type":"RC"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF NOSE POLYP-PBB","code_information":[{"code":"2931203","type":"CDM"},{"code":"361","type":"RC"},{"code":"30110","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.5,"setting":"both","billing_class":"professional"}]},{"description":"REM NASAL FOREIGN BODY-PBB","code_information":[{"code":"2931206","type":"CDM"},{"code":"361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"ABLATE INF TURBINATE-PBB","code_information":[{"code":"2931209","type":"CDM"},{"code":"361","type":"RC"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSEBLEED-PBB","code_information":[{"code":"2931212","type":"CDM"},{"code":"361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"REPEAT CONTROL OF NOSEBL-PBB","code_information":[{"code":"2931215","type":"CDM"},{"code":"361","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.75,"setting":"both","billing_class":"professional"}]},{"description":"NASAL ENDO  DX-PBB","code_information":[{"code":"2931218","type":"CDM"},{"code":"361","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX MAX ENDO-PBB","code_information":[{"code":"2931221","type":"CDM"},{"code":"361","type":"RC"},{"code":"31233","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.75,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC DX SPHN ENDO-PBB","code_information":[{"code":"2931224","type":"CDM"},{"code":"361","type":"RC"},{"code":"31235","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.5,"setting":"both","billing_class":"professional"}]},{"description":"NSL/SINS NDSC BX POLYPC-PBB","code_information":[{"code":"2931227","type":"CDM"},{"code":"361","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.25,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC LARYNGOSCOPY-PBB","code_information":[{"code":"2931233","type":"CDM"},{"code":"361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"setting":"both","billing_class":"professional"}]},{"description":"INJ THERAPY OF VEINS-PBB","code_information":[{"code":"2931238","type":"CDM"},{"code":"361","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF TONGUE FOLD-PBB","code_information":[{"code":"2931239","type":"CDM"},{"code":"361","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-PBB","code_information":[{"code":"2931241","type":"CDM"},{"code":"361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"REM TUNNELED CV CATH-PBB","code_information":[{"code":"2931244","type":"CDM"},{"code":"361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF LIP-PBB","code_information":[{"code":"2931500","type":"CDM"},{"code":"361","type":"RC"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF LIP FOLD-PBB","code_information":[{"code":"2931503","type":"CDM"},{"code":"361","type":"RC"},{"code":"40806","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF MOUTH LESION-PBB","code_information":[{"code":"2931506","type":"CDM"},{"code":"361","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"EX OF MOUTH LESION-PBB","code_information":[{"code":"2931509","type":"CDM"},{"code":"361","type":"RC"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISE/REPAIR MOUTH LESION-PBB","code_information":[{"code":"2931512","type":"CDM"},{"code":"361","type":"RC"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF TONGUE-PBB","code_information":[{"code":"2931518","type":"CDM"},{"code":"361","type":"RC"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"EX OF TONGUE LESION-PBB","code_information":[{"code":"2931521","type":"CDM"},{"code":"361","type":"RC"},{"code":"41110","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.75,"setting":"both","billing_class":"professional"}]},{"description":"EX OF TONGUE FOLD-PBB","code_information":[{"code":"2931524","type":"CDM"},{"code":"361","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.25,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION  MOUTH ROOF-PBB","code_information":[{"code":"2931527","type":"CDM"},{"code":"361","type":"RC"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.75,"setting":"both","billing_class":"professional"}]},{"description":"EX LESION  MOUTH ROOF-PBB","code_information":[{"code":"2931530","type":"CDM"},{"code":"361","type":"RC"},{"code":"42106","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF SALIVARY GLAND-PBB","code_information":[{"code":"2931533","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF TONSIL ABSC-PBB","code_information":[{"code":"2931536","type":"CDM"},{"code":"361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF THROAT-PBB","code_information":[{"code":"2931539","type":"CDM"},{"code":"361","type":"RC"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"EXISE PHARYNX LESION-PBB","code_information":[{"code":"2931542","type":"CDM"},{"code":"361","type":"RC"},{"code":"42808","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE GASTROSTOMY TUBE-PBB","code_information":[{"code":"2931545","type":"CDM"},{"code":"361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"PROCTOSIGMOIDOSCOPY DX-PBB","code_information":[{"code":"2931548","type":"CDM"},{"code":"361","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF RECTAL ABSC-PBB","code_information":[{"code":"2931551","type":"CDM"},{"code":"361","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF ANAL ABSCESS-PBB","code_information":[{"code":"2931554","type":"CDM"},{"code":"361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISE EXT HEMORRHOID-PBB","code_information":[{"code":"2931557","type":"CDM"},{"code":"361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"setting":"both","billing_class":"professional"}]},{"description":"LIGATION OF HEMORRHOID-PBB","code_information":[{"code":"2931560","type":"CDM"},{"code":"361","type":"RC"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL TAGS-PBB","code_information":[{"code":"2931563","type":"CDM"},{"code":"361","type":"RC"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"setting":"both","billing_class":"professional"}]},{"description":"REM OF HEMORRHOID CLOT-PBB","code_information":[{"code":"2931566","type":"CDM"},{"code":"361","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.25,"setting":"both","billing_class":"professional"}]},{"description":"DIAGNOSTIC ANOSCOPY-PBB","code_information":[{"code":"2931569","type":"CDM"},{"code":"361","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY AND DILATION-PBB","code_information":[{"code":"2931572","type":"CDM"},{"code":"361","type":"RC"},{"code":"46604","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"ANOSCOPY AND BX-PBB","code_information":[{"code":"2931575","type":"CDM"},{"code":"361","type":"RC"},{"code":"46606","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT  ANAL LESION-PBB","code_information":[{"code":"2931578","type":"CDM"},{"code":"361","type":"RC"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.75,"setting":"both","billing_class":"professional"}]},{"description":"EX OF ANAL LESION-PBB","code_information":[{"code":"2931581","type":"CDM"},{"code":"361","type":"RC"},{"code":"46922","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EA-PBB","code_information":[{"code":"2931582","type":"CDM"},{"code":"361","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"setting":"both","billing_class":"professional"}]},{"description":"TX FINGER FX EA-PBB","code_information":[{"code":"2931583","type":"CDM"},{"code":"361","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.5,"setting":"both","billing_class":"professional"}]},{"description":"REPL DUOD/JEJ TUBE PERC-PBB","code_information":[{"code":"2931584","type":"CDM"},{"code":"361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.25,"setting":"both","billing_class":"professional"}]},{"description":"IRRIGATION OF BLADDER-PBB","code_information":[{"code":"2931800","type":"CDM"},{"code":"361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT BLADDER CATHETER-PBB","code_information":[{"code":"2931803","type":"CDM"},{"code":"361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT TEMP BLADDER CATH-PBB","code_information":[{"code":"2931806","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE OF BLADDER TUBE-PBB","code_information":[{"code":"2931809","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"URCUFF TEST-PBB","code_information":[{"code":"2931813","type":"CDM"},{"code":"361","type":"RC"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","modifiers":"52","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"ELECTRO/UROFLOWMETRY 1ST-PBB","code_information":[{"code":"2931815","type":"CDM"},{"code":"361","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-PBB","code_information":[{"code":"2931818","type":"CDM"},{"code":"361","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"ANAL/URINARY MUSC STUDY-PBB","code_information":[{"code":"2931821","type":"CDM"},{"code":"361","type":"RC"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"professional"}]},{"description":"INTRAABD PRESSURE TST-PBB","code_information":[{"code":"2931824","type":"CDM"},{"code":"361","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"US URINE CAPACITY MEASURE-PBB","code_information":[{"code":"2931827","type":"CDM"},{"code":"361","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY-PBB","code_information":[{"code":"2931830","type":"CDM"},{"code":"361","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY W BX  PROF-PBB","code_information":[{"code":"2931833","type":"CDM"},{"code":"361","type":"RC"},{"code":"52204","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-PBB","code_information":[{"code":"2931836","type":"CDM"},{"code":"361","type":"RC"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-PBB","code_information":[{"code":"2931841","type":"CDM"},{"code":"361","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TREAT-PBB","code_information":[{"code":"2931844","type":"CDM"},{"code":"361","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"DILATE URETHRA STRICTURE-PBB","code_information":[{"code":"2931847","type":"CDM"},{"code":"361","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"DILATION OF URETHRA-PBB","code_information":[{"code":"2931850","type":"CDM"},{"code":"361","type":"RC"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATION OF URETHRA-PBB","code_information":[{"code":"2931853","type":"CDM"},{"code":"361","type":"RC"},{"code":"53661","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT  PENIS LESION-PBB","code_information":[{"code":"2931856","type":"CDM"},{"code":"361","type":"RC"},{"code":"54050","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT  PENIS LESION-PBB","code_information":[{"code":"2931859","type":"CDM"},{"code":"361","type":"RC"},{"code":"54055","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"CRYOSURGERY  PENIS LESION-PBB","code_information":[{"code":"2931862","type":"CDM"},{"code":"361","type":"RC"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS PENIL CIRCUMIC LES-PBB","code_information":[{"code":"2931865","type":"CDM"},{"code":"361","type":"RC"},{"code":"54162","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT OF PENIS LESION-PBB","code_information":[{"code":"2931868","type":"CDM"},{"code":"361","type":"RC"},{"code":"54200","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.75,"setting":"both","billing_class":"professional"}]},{"description":"PREPUTIAL STRETCHING-PBB","code_information":[{"code":"2931871","type":"CDM"},{"code":"361","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SCROTUM-PBB","code_information":[{"code":"2931874","type":"CDM"},{"code":"361","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF HYDROCELE-PBB","code_information":[{"code":"2931877","type":"CDM"},{"code":"361","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF SCROTUM ABSC-PBB","code_information":[{"code":"2931880","type":"CDM"},{"code":"361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF SPERM DUCT-PBB","code_information":[{"code":"2931883","type":"CDM"},{"code":"361","type":"RC"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF PROSTATE-PBB","code_information":[{"code":"2931886","type":"CDM"},{"code":"361","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"I & D OF VULVA/PERINEUM-PBB","code_information":[{"code":"2931889","type":"CDM"},{"code":"361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE OF GLAND ABSCESS-PBB","code_information":[{"code":"2931892","type":"CDM"},{"code":"361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VULVA LESIONS SIM-PBB","code_information":[{"code":"2931895","type":"CDM"},{"code":"361","type":"RC"},{"code":"56501","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VULVA LESION CMPLX-PBB","code_information":[{"code":"2931898","type":"CDM"},{"code":"361","type":"RC"},{"code":"56515","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-PBB","code_information":[{"code":"2931901","type":"CDM"},{"code":"361","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VULVA/PERINEUM-PBB","code_information":[{"code":"2931904","type":"CDM"},{"code":"361","type":"RC"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VAG LESIONS-PBB","code_information":[{"code":"2931907","type":"CDM"},{"code":"361","type":"RC"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY VAG LES COMPL-PBB","code_information":[{"code":"2931910","type":"CDM"},{"code":"361","type":"RC"},{"code":"57065","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"setting":"both","billing_class":"professional"}]},{"description":"BX OF VAGINA-PBB","code_information":[{"code":"2931913","type":"CDM"},{"code":"361","type":"RC"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT PESSARY/OTH DEVICE-PBB","code_information":[{"code":"2931916","type":"CDM"},{"code":"361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"EXAM/BX OF VAG W/SCOPE-PBB","code_information":[{"code":"2931919","type":"CDM"},{"code":"361","type":"RC"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.25,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF CERVIX W/SCOPE-PBB","code_information":[{"code":"2931922","type":"CDM"},{"code":"361","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"professional"}]},{"description":"BX/CURETT OF CERV W/SC-PBB","code_information":[{"code":"2931925","type":"CDM"},{"code":"361","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX W/SCOPE LEEP-PBB","code_information":[{"code":"2931928","type":"CDM"},{"code":"361","type":"RC"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.25,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY CERV W/SC LEEP-PBB","code_information":[{"code":"2931929","type":"CDM"},{"code":"361","type":"RC"},{"code":"57461","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF CERVIX-PBB","code_information":[{"code":"2931931","type":"CDM"},{"code":"361","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"CONIZATION OF CERVIX-PBB","code_information":[{"code":"2931934","type":"CDM"},{"code":"361","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF UTERUS LINING-PBB","code_information":[{"code":"2931937","type":"CDM"},{"code":"361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT INTRAUTERINE DEV-PBB","code_information":[{"code":"2931940","type":"CDM"},{"code":"361","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"REM INTRAUTERINE DEVICE-PBB","code_information":[{"code":"2931943","type":"CDM"},{"code":"361","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL FLUID TAP-PBB","code_information":[{"code":"2932200","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  TRIGEMINAL-PBB","code_information":[{"code":"2932203","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  OCCIP BIL-PBB","code_information":[{"code":"2932206","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"N BLOCK INJ  PUDENDAL-PBB","code_information":[{"code":"2932209","type":"CDM"},{"code":"361","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK  OTHER PERIPHERAL-PBB","code_information":[{"code":"2932212","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ PLANTAR DIGIT-PBB","code_information":[{"code":"2932215","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTR W NEUROLYTIC AGENT-PBB","code_information":[{"code":"2932217","type":"CDM"},{"code":"361","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN SALIV GLANDS-PBB","code_information":[{"code":"2932218","type":"CDM"},{"code":"361","type":"RC"},{"code":"64611","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE  FACE MUSC-PBB","code_information":[{"code":"2932221","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC MIGRAINE-PBB","code_information":[{"code":"2932224","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK DYSTON-PBB","code_information":[{"code":"2932227","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTR 1-4 MUSCS-PBB","code_information":[{"code":"2932230","type":"CDM"},{"code":"361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTR 1-4 ADDL-PBB","code_information":[{"code":"2932233","type":"CDM"},{"code":"361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EXTREM 5/> MUS-PBB","code_information":[{"code":"2932236","type":"CDM"},{"code":"361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN 1 EX 5/> EA ADDL-PBB","code_information":[{"code":"2932239","type":"CDM"},{"code":"361","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"EX NEUROMA CUTANEOUS-PBB","code_information":[{"code":"2932242","type":"CDM"},{"code":"361","type":"RC"},{"code":"64774","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FROM EYE-PBB","code_information":[{"code":"2932245","type":"CDM"},{"code":"361","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROTOMY DRAIN ABSC-PBB","code_information":[{"code":"2932248","type":"CDM"},{"code":"361","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN EXTERNAL EAR LESION-PBB","code_information":[{"code":"2932251","type":"CDM"},{"code":"361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN EXTERNAL EAR LESION-PBB","code_information":[{"code":"2932254","type":"CDM"},{"code":"361","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF EXTERNAL EAR-PBB","code_information":[{"code":"2932257","type":"CDM"},{"code":"361","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"BX OF EXTERNAL EAR CANAL-PBB","code_information":[{"code":"2932260","type":"CDM"},{"code":"361","type":"RC"},{"code":"69105","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"professional"}]},{"description":"CLEAR OUTER EAR CANAL-PBB","code_information":[{"code":"2932263","type":"CDM"},{"code":"361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPCT EARWAX W/TOOL-PBB","code_information":[{"code":"2932269","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"CLEAN OUT MASTOID CAVITY-PBB","code_information":[{"code":"2932272","type":"CDM"},{"code":"361","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF EARDRUM-PBB","code_information":[{"code":"2932275","type":"CDM"},{"code":"361","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.25,"setting":"both","billing_class":"professional"}]},{"description":"CREATE EARDRUM OPENING-PBB","code_information":[{"code":"2932278","type":"CDM"},{"code":"361","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISE INNER EAR-PBB","code_information":[{"code":"2932281","type":"CDM"},{"code":"361","type":"RC"},{"code":"69801","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE 1 OR 2 VIEW LT-PBB","code_information":[{"code":"2932401","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 3 VIEW LT-PBB","code_information":[{"code":"2932402","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY KNEE 4 VIEW LT-PBB","code_information":[{"code":"2932403","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"setting":"both","modifiers":"26|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"REM IMPACTED EARWAX BIL-PBB","code_information":[{"code":"2932404","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REM EYELID LESIONS BIL-PBB","code_information":[{"code":"2932405","type":"CDM"},{"code":"510","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSE TEAR DUCTS OPEN BIL-PBB","code_information":[{"code":"2932406","type":"CDM"},{"code":"510","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"BX OF CERVIX W/SCOPE-PBB","code_information":[{"code":"2932407","type":"CDM"},{"code":"510","type":"RC"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPEN BIL-PBB","code_information":[{"code":"2932408","type":"CDM"},{"code":"361","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"UNLISTED PX LUNGS & PLEURA-PBB","code_information":[{"code":"2932411","type":"CDM"},{"code":"510","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 30MINS-PBB","code_information":[{"code":"2932412","type":"CDM"},{"code":"914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 45MINS-PBB","code_information":[{"code":"2932413","type":"CDM"},{"code":"914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"setting":"both","billing_class":"professional"}]},{"description":"PSYCH THERAPY W/PT 60MINS-PBB","code_information":[{"code":"2932414","type":"CDM"},{"code":"914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.25,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UP LID BIL-PBB","code_information":[{"code":"2932415","type":"CDM"},{"code":"510","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REMOVAL OF IMPLANT DEEP-PBB","code_information":[{"code":"2932416","type":"CDM"},{"code":"360","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.5,"setting":"both","billing_class":"professional"}]},{"description":"PLETHYSMOGRAPHY (PFT)-PBB","code_information":[{"code":"2932417","type":"CDM"},{"code":"510","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.5,"setting":"both","billing_class":"professional"}]},{"description":"DIFFUSING CAPACITY-PBB","code_information":[{"code":"2932418","type":"CDM"},{"code":"510","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"setting":"both","billing_class":"professional"}]},{"description":"ABD PARACENTESIS W/IMAGE-PBB","code_information":[{"code":"2932419","type":"CDM"},{"code":"510","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW HIGH 60 MIN-PBB","code_information":[{"code":"2932420","type":"CDM"},{"code":"960","type":"RC"},{"code":"98011","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST SF 10 MIN-PBB","code_information":[{"code":"2932421","type":"CDM"},{"code":"960","type":"RC"},{"code":"98012","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST LOW 20 MIN-PBB","code_information":[{"code":"2932422","type":"CDM"},{"code":"960","type":"RC"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST MOD 30 MIN-PBB","code_information":[{"code":"2932423","type":"CDM"},{"code":"960","type":"RC"},{"code":"98014","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST HIGH 40 MIN-PBB","code_information":[{"code":"2932424","type":"CDM"},{"code":"960","type":"RC"},{"code":"98015","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"setting":"both","billing_class":"professional"}]},{"description":"ESCHAROTOMY 1ST INCISION-PBB","code_information":[{"code":"2932425","type":"CDM"},{"code":"360","type":"RC"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF RIBS-PBB","code_information":[{"code":"2932500","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF BREASTBONE-PBB","code_information":[{"code":"2932503","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-PBB","code_information":[{"code":"2932506","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-PBB","code_information":[{"code":"2932509","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF NECK SPINE-PBB","code_information":[{"code":"2932512","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF THORACIC SPINE-PBB","code_information":[{"code":"2932515","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF TRUNK SPINE-PBB","code_information":[{"code":"2932518","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPI 2/3 VW-PBB","code_information":[{"code":"2932521","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-PBB","code_information":[{"code":"2932524","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-PBB","code_information":[{"code":"2932527","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF PELVIS-PBB","code_information":[{"code":"2932530","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF TAILBONE-PBB","code_information":[{"code":"2932533","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY COLLAR BONE-PBB","code_information":[{"code":"2932536","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF SHOULDER BLADE-PBB","code_information":[{"code":"2932539","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF SHOULDER-PBB","code_information":[{"code":"2932542","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER 2 VIEW RT-PBB","code_information":[{"code":"2932545","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY OF SHOULDERS-PBB","code_information":[{"code":"2932548","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SHOULDER CMPLT BIL-PBB","code_information":[{"code":"2932549","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY HUMERUS-PBB","code_information":[{"code":"2932551","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ELBOW-PBB","code_information":[{"code":"2932554","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ELBOW 3 VIEW RT-PBB","code_information":[{"code":"2932557","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FOREARM-PBB","code_information":[{"code":"2932560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST-PBB","code_information":[{"code":"2932563","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST 3 VIEW RT-PBB","code_information":[{"code":"2932566","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.25,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HAND-PBB","code_information":[{"code":"2932569","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HAND 3 VIEW RT-PBB","code_information":[{"code":"2932572","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.25,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY FINGER-PBB","code_information":[{"code":"2932575","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP UNI 1 VIEW-PBB","code_information":[{"code":"2932578","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP 2-3 VIEW RT-PBB","code_information":[{"code":"2932581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY HIP UNI 4/> VIEWS-PBB","code_information":[{"code":"2932584","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 2 VIEWS-PBB","code_information":[{"code":"2932587","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 3-4 VIEWS-PBB","code_information":[{"code":"2932590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIPS BI 5/> VIEWS-PBB","code_information":[{"code":"2932593","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF FEMUR 1-PBB","code_information":[{"code":"2932596","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF FEMUR 2/>-PBB","code_information":[{"code":"2932599","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY KNEE 1 OR 2 VIEW RT-PBB","code_information":[{"code":"2932602","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 3 VIEW RT-PBB","code_information":[{"code":"2932605","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEE 4 VIEW RT-PBB","code_information":[{"code":"2932608","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"setting":"both","modifiers":"26|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEES BIL STANDING-PBB","code_information":[{"code":"2932611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER LEG-PBB","code_information":[{"code":"2932614","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF LEG  INFANT-PBB","code_information":[{"code":"2932617","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ANKLE-PBB","code_information":[{"code":"2932620","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ANKLE-PBB","code_information":[{"code":"2932623","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF KNEE BILATERAL-PBB","code_information":[{"code":"2932624","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 3 VIEW BILAT-PBB","code_information":[{"code":"2932625","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY FOOT-PBB","code_information":[{"code":"2932626","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FOOT-PBB","code_information":[{"code":"2932629","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HEEL-PBB","code_information":[{"code":"2932632","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY TOE-PBB","code_information":[{"code":"2932635","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND HEAD AND NECK-PBB","code_information":[{"code":"2932638","type":"CDM"},{"code":"320","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND TRANSRECTAL-PBB","code_information":[{"code":"2932641","type":"CDM"},{"code":"320","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"ECHO GUIDE FOR BX-PBB","code_information":[{"code":"2932644","type":"CDM"},{"code":"320","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"ULTRASOUND RETROPERITONEAL-PBB","code_information":[{"code":"2932647","type":"CDM"},{"code":"510","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MNL APPL STRESS JNT-PBB","code_information":[{"code":"2932648","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.75,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"BREATH HYDROGEN TST-PBB","code_information":[{"code":"2933343","type":"CDM"},{"code":"510","type":"RC"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG ANT-PBB","code_information":[{"code":"2933346","type":"CDM"},{"code":"510","type":"RC"},{"code":"92132","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH IMG OPTIC NRV-PBB","code_information":[{"code":"2933349","type":"CDM"},{"code":"510","type":"RC"},{"code":"92133","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"CMPTR OPHTH DX IMG POST-PBB","code_information":[{"code":"2933352","type":"CDM"},{"code":"510","type":"RC"},{"code":"92134","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"EAR MICROSCOPY EXAM-PBB","code_information":[{"code":"2933355","type":"CDM"},{"code":"510","type":"RC"},{"code":"92504","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"CALORIC VSTBLR TST W/REC-PBB","code_information":[{"code":"2933358","type":"CDM"},{"code":"510","type":"RC"},{"code":"92537","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"CALORIC VSTBLR TST W/REC-PBB","code_information":[{"code":"2933361","type":"CDM"},{"code":"510","type":"RC"},{"code":"92538","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"BASIC VESTIBULAR EVAL-PBB","code_information":[{"code":"2933364","type":"CDM"},{"code":"510","type":"RC"},{"code":"92540","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.75,"setting":"both","billing_class":"professional"}]},{"description":"SPONTANEOUS NYSTAGMUS TST-PBB","code_information":[{"code":"2933367","type":"CDM"},{"code":"510","type":"RC"},{"code":"92541","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"COMPREHENSIVE HEARING TST-PBB","code_information":[{"code":"2933370","type":"CDM"},{"code":"510","type":"RC"},{"code":"92557","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"TYMPANOMETRY-PBB","code_information":[{"code":"2933373","type":"CDM"},{"code":"510","type":"RC"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"BREATHING CAPACITY TST-PBB","code_information":[{"code":"2933388","type":"CDM"},{"code":"510","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"professional"}]},{"description":"EVALUATION OF WHEEZING-PBB","code_information":[{"code":"2933391","type":"CDM"},{"code":"510","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"PULMONARY STRESS TSTING-PBB","code_information":[{"code":"2933394","type":"CDM"},{"code":"510","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST 1 LIMB-PBB","code_information":[{"code":"2933421","type":"CDM"},{"code":"510","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRAN NRV UNIL-PBB","code_information":[{"code":"2933424","type":"CDM"},{"code":"510","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG THORACIC-PBB","code_information":[{"code":"2933427","type":"CDM"},{"code":"510","type":"RC"},{"code":"95869","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST  NONPARASPINAL-PBB","code_information":[{"code":"2933430","type":"CDM"},{"code":"510","type":"RC"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"GUIDE NERV DESTR NDL EMG-PBB","code_information":[{"code":"2933433","type":"CDM"},{"code":"510","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/NERV TST LIM-PBB","code_information":[{"code":"2933436","type":"CDM"},{"code":"510","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/N TST COMP-PBB","code_information":[{"code":"2933439","type":"CDM"},{"code":"510","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSC TST W/N TST NONEXT-PBB","code_information":[{"code":"2933442","type":"CDM"},{"code":"510","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 1-2 NRV CNDJ-PBB","code_information":[{"code":"2933445","type":"CDM"},{"code":"510","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 3-4 NRV CNDJ-PBB","code_information":[{"code":"2933448","type":"CDM"},{"code":"510","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 5-6 NRV CNDJ-PBB","code_information":[{"code":"2933451","type":"CDM"},{"code":"510","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 7-8 NRV CNDJ-PBB","code_information":[{"code":"2933454","type":"CDM"},{"code":"510","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SEN 9-10 NRV CNDJ-PBB","code_information":[{"code":"2933457","type":"CDM"},{"code":"510","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SEN 11-12 NRV CND-PBB","code_information":[{"code":"2933460","type":"CDM"},{"code":"510","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.5,"setting":"both","billing_class":"professional"}]},{"description":"MOTOR&SENS 13/> NRV CND-PBB","code_information":[{"code":"2933463","type":"CDM"},{"code":"510","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"CANALITH REPOSITIONING-PBB","code_information":[{"code":"2933469","type":"CDM"},{"code":"510","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE/20 CM OR <-PBB","code_information":[{"code":"2933481","type":"CDM"},{"code":"510","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"ACTIVE WOUND CARE > 20 CM-PBB","code_information":[{"code":"2933484","type":"CDM"},{"code":"510","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WOUND TX< 50CM-PBB","code_information":[{"code":"2933487","type":"CDM"},{"code":"510","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WOUND TX >50CM-PBB","code_information":[{"code":"2933490","type":"CDM"},{"code":"510","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 1-2 REGNS-PBB","code_information":[{"code":"2933493","type":"CDM"},{"code":"510","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 3-4 REGNS-PBB","code_information":[{"code":"2933496","type":"CDM"},{"code":"510","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 2 NEW-PBB","code_information":[{"code":"2933509","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 3 NEW-PBB","code_information":[{"code":"2933510","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 4 NEW-PBB","code_information":[{"code":"2933511","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 5 NEW-PBB","code_information":[{"code":"2933514","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.5,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 1 EST-PBB","code_information":[{"code":"2933515","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 2 EST-PBB","code_information":[{"code":"2933516","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 3 EST-PBB","code_information":[{"code":"2933517","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 4 EST-PBB","code_information":[{"code":"2933518","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE VISIT LEV 5 EST-PBB","code_information":[{"code":"2933519","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT STRT FWD-PBB","code_information":[{"code":"2933521","type":"CDM"},{"code":"510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT MOD LEVEL-PBB","code_information":[{"code":"2933522","type":"CDM"},{"code":"510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT HIGH LEVEL-PBB","code_information":[{"code":"2933523","type":"CDM"},{"code":"510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  INFANT-PBB","code_information":[{"code":"2933524","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  AGE 1-4-PBB","code_information":[{"code":"2933525","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  NEW  AGE 5-11-PBB","code_information":[{"code":"2933526","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 12-17-PBB","code_information":[{"code":"2933527","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 18-39-PBB","code_information":[{"code":"2933528","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW AGE 40-64-PBB","code_information":[{"code":"2933529","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT NEW 65 & OVER-PBB","code_information":[{"code":"2933530","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  INFANT-PBB","code_information":[{"code":"2933531","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  AGE 1-4-PBB","code_information":[{"code":"2933532","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT  EST  AGE 5-11-PBB","code_information":[{"code":"2933533","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 12-17-PBB","code_information":[{"code":"2933534","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 18-39-PBB","code_information":[{"code":"2933535","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST AGE 40-64-PBB","code_information":[{"code":"2933536","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"setting":"both","billing_class":"professional"}]},{"description":"PREV VISIT EST 65 & OVER-PBB","code_information":[{"code":"2933537","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","billing_class":"professional"}]},{"description":"OFFICE CONSULT LOW LEVEL-PBB","code_information":[{"code":"2933549","type":"CDM"},{"code":"510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"setting":"both","billing_class":"professional"}]},{"description":"INITIAL PREVENTIVE EXAM-PBB","code_information":[{"code":"2933881","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"DEPRESSION SCREEN ANNUAL-PBB","code_information":[{"code":"2933894","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"TPRNL BIODEGRADE MATRL-PBB","code_information":[{"code":"2935014","type":"CDM"},{"code":"361","type":"RC"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.75,"setting":"both","billing_class":"professional"}]},{"description":"PLACE DEVICE/MARKER-PBB","code_information":[{"code":"2935015","type":"CDM"},{"code":"361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE SKIN/MSCL FX-PBB","code_information":[{"code":"2935016","type":"CDM"},{"code":"361","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.75,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE LES F/E/N/L >2CM-PBB","code_information":[{"code":"2935017","type":"CDM"},{"code":"361","type":"RC"},{"code":"11313","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/O IMAGE ADDL-PBB","code_information":[{"code":"2935018","type":"CDM"},{"code":"361","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN-PBB","code_information":[{"code":"2935019","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/ US GDN ADDL-PBB","code_information":[{"code":"2935020","type":"CDM"},{"code":"361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"TREAT ANKLE FX-PBB","code_information":[{"code":"2935021","type":"CDM"},{"code":"361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.75,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN SINGLE LES-PBB","code_information":[{"code":"2935069","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"PUNCH BX SKIN EA SEP/ADDL-PBB","code_information":[{"code":"2935070","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN EA SEP/ADDL-PBB","code_information":[{"code":"2935072","type":"CDM"},{"code":"361","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"DEB MSC/FASCIA ADDL =<20CM-PBB","code_information":[{"code":"2935073","type":"CDM"},{"code":"361","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC F/E/N/L MAL 0.5CM<-PBB","code_information":[{"code":"2935074","type":"CDM"},{"code":"361","type":"RC"},{"code":"11640","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.75,"setting":"both","billing_class":"professional"}]},{"description":"I&D FOREARM/WRIST-PBB","code_information":[{"code":"2935077","type":"CDM"},{"code":"361","type":"RC"},{"code":"25031","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX MALLET FINGER-PBB","code_information":[{"code":"2935078","type":"CDM"},{"code":"361","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX TARSAL DISLOCATION-PBB","code_information":[{"code":"2935079","type":"CDM"},{"code":"361","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL NASAL HEMORR-PBB","code_information":[{"code":"2935080","type":"CDM"},{"code":"361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE FB EYE-PBB","code_information":[{"code":"2935081","type":"CDM"},{"code":"361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE FB EYE-PBB","code_information":[{"code":"2935082","type":"CDM"},{"code":"361","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"SHAVE LES S/N/H/F/G >2CM-PBB","code_information":[{"code":"2935095","type":"CDM"},{"code":"361","type":"RC"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC F/E/E/N/L >4CM-PBB","code_information":[{"code":"2935096","type":"CDM"},{"code":"361","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC LES S/N/EX G >4CM-PBB","code_information":[{"code":"2935097","type":"CDM"},{"code":"361","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ INTO SKIN LES >7-PBB","code_information":[{"code":"2935098","type":"CDM"},{"code":"361","type":"RC"},{"code":"11901","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND S/N/A/TR/E-PBB","code_information":[{"code":"2935099","type":"CDM"},{"code":"361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND F/E/N/L-PBB","code_information":[{"code":"2935100","type":"CDM"},{"code":"361","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"REP SUP WND F/E/N/L-PBB","code_information":[{"code":"2935101","type":"CDM"},{"code":"361","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"TX WND DEHIS-PBB","code_information":[{"code":"2935102","type":"CDM"},{"code":"361","type":"RC"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-PBB","code_information":[{"code":"2935103","type":"CDM"},{"code":"361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/A/T/E-PBB","code_information":[{"code":"2935104","type":"CDM"},{"code":"361","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.25,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND S/T/E-PBB","code_information":[{"code":"2935105","type":"CDM"},{"code":"361","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND N/H/F/E-PBB","code_information":[{"code":"2935106","type":"CDM"},{"code":"361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.5,"setting":"both","billing_class":"professional"}]},{"description":"REP INT WND N/H/F/E-PBB","code_information":[{"code":"2935107","type":"CDM"},{"code":"361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.75,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/E/N/L/MM 5.1-7.5-PBB","code_information":[{"code":"2935108","type":"CDM"},{"code":"361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 12.6-20-PBB","code_information":[{"code":"2935109","type":"CDM"},{"code":"361","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 20.1-30-PBB","code_information":[{"code":"2935110","type":"CDM"},{"code":"361","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR N/H/F/G 30+PBB","code_information":[{"code":"2935111","type":"CDM"},{"code":"361","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.75,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 5.1-7.5-PBB","code_information":[{"code":"2935112","type":"CDM"},{"code":"361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 7.6-12.5-PBB","code_information":[{"code":"2935113","type":"CDM"},{"code":"361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 12.6-20-PBB","code_information":[{"code":"2935114","type":"CDM"},{"code":"361","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 20.1-30-PBB","code_information":[{"code":"2935115","type":"CDM"},{"code":"361","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.5,"setting":"both","billing_class":"professional"}]},{"description":"WND RPR F/MM 30+PBB","code_information":[{"code":"2935116","type":"CDM"},{"code":"361","type":"RC"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES 10-50CM-PBB","code_information":[{"code":"2935118","type":"CDM"},{"code":"361","type":"RC"},{"code":"17107","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR CV LES >50CM-PBB","code_information":[{"code":"2935119","type":"CDM"},{"code":"361","type":"RC"},{"code":"17108","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L .5CM/< -PBB","code_information":[{"code":"2935120","type":"CDM"},{"code":"361","type":"RC"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L .6-1CM -PBB","code_information":[{"code":"2935121","type":"CDM"},{"code":"361","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L 2.1-3CM-PBB","code_information":[{"code":"2935122","type":"CDM"},{"code":"361","type":"RC"},{"code":"17263","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L 3.1-4CM-PBB","code_information":[{"code":"2935123","type":"CDM"},{"code":"361","type":"RC"},{"code":"17264","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTR LES T/A/L >5CM-PBB","code_information":[{"code":"2935124","type":"CDM"},{"code":"361","type":"RC"},{"code":"17266","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"PUNCT ASP BRST ADDL-PBB","code_information":[{"code":"2935125","type":"CDM"},{"code":"361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR TUM DEEP >5CM-PBB","code_information":[{"code":"2935126","type":"CDM"},{"code":"361","type":"RC"},{"code":"23073","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR LES <3CM-PBB","code_information":[{"code":"2935127","type":"CDM"},{"code":"361","type":"RC"},{"code":"23075","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC SHLDR TUM DEEP <5CM-PBB","code_information":[{"code":"2935128","type":"CDM"},{"code":"361","type":"RC"},{"code":"23076","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"setting":"both","billing_class":"professional"}]},{"description":"LAVAGE BY CANNULA-PBB","code_information":[{"code":"2935129","type":"CDM"},{"code":"361","type":"RC"},{"code":"31000","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW ASPIR-PBB","code_information":[{"code":"2935130","type":"CDM"},{"code":"361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW BX-PBB","code_information":[{"code":"2935131","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"DX BONE MARROW BX&ASPIR-PBB","code_information":[{"code":"2935132","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY ANAL LES-PBB","code_information":[{"code":"2935133","type":"CDM"},{"code":"361","type":"RC"},{"code":"46924","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PBB","code_information":[{"code":"2935134","type":"CDM"},{"code":"361","type":"RC"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY AND TX-PBB","code_information":[{"code":"2935136","type":"CDM"},{"code":"361","type":"RC"},{"code":"52260","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOSCOPY CHEMODENERV-PBB","code_information":[{"code":"2935137","type":"CDM"},{"code":"361","type":"RC"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"PROSTATIC THERMOTHERAPY-PBB","code_information":[{"code":"2935138","type":"CDM"},{"code":"361","type":"RC"},{"code":"53850","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION PENIS LES-PBB","code_information":[{"code":"2935139","type":"CDM"},{"code":"361","type":"RC"},{"code":"54065","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"setting":"both","billing_class":"professional"}]},{"description":"INJ CORPORA CAVERNOSA-PBB","code_information":[{"code":"2935140","type":"CDM"},{"code":"361","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.75,"setting":"both","billing_class":"professional"}]},{"description":"COLPOSCOPY OF VULVA-PBB","code_information":[{"code":"2935141","type":"CDM"},{"code":"361","type":"RC"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"BX VAGINAL MUCOSA-PBB","code_information":[{"code":"2935142","type":"CDM"},{"code":"361","type":"RC"},{"code":"57105","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"REM VAGINAL FB-PBB","code_information":[{"code":"2935143","type":"CDM"},{"code":"361","type":"RC"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"professional"}]},{"description":"EXAM OF VAGINA W/SCOPE-PBB","code_information":[{"code":"2935144","type":"CDM"},{"code":"361","type":"RC"},{"code":"57420","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"REM VENTIL TUBE/ANESTH-PBB","code_information":[{"code":"2935145","type":"CDM"},{"code":"361","type":"RC"},{"code":"69424","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"EKG REPORT/INTERPRET-PBB","code_information":[{"code":"2935152","type":"CDM"},{"code":"730","type":"RC"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY MASTOIDS >3-PBB","code_information":[{"code":"2935156","type":"CDM"},{"code":"361","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES <3-PBB","code_information":[{"code":"2935157","type":"CDM"},{"code":"361","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FACIAL BONES >3-PBB","code_information":[{"code":"2935158","type":"CDM"},{"code":"361","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OPTIC FORAMINA-PBB","code_information":[{"code":"2935159","type":"CDM"},{"code":"361","type":"RC"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY NECK SOFT TISS-PBB","code_information":[{"code":"2935160","type":"CDM"},{"code":"361","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY CHEST 1 VIEW-PBB","code_information":[{"code":"2935161","type":"CDM"},{"code":"361","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY CHEST 2 VIEWS-PBB","code_information":[{"code":"2935162","type":"CDM"},{"code":"361","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS/CHEST >3 UNIL-PBB","code_information":[{"code":"2935163","type":"CDM"},{"code":"361","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS/CHEST >4 BILAT-PBB","code_information":[{"code":"2935164","type":"CDM"},{"code":"361","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 1 VIEW-PBB","code_information":[{"code":"2935166","type":"CDM"},{"code":"361","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.25,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABDOMEN 2 VIEWS-PBB","code_information":[{"code":"2935167","type":"CDM"},{"code":"361","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ABD COMPL ACUTE-PBB","code_information":[{"code":"2935168","type":"CDM"},{"code":"361","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ SM JNT/BUR W/US-PBB","code_information":[{"code":"2935173","type":"CDM"},{"code":"361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ INT JNT/BUR W/US-PBB","code_information":[{"code":"2935174","type":"CDM"},{"code":"361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"EX TUMOR/FC/SC SUBQ <2CM-PBB","code_information":[{"code":"2935175","type":"CDM"},{"code":"361","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY RIBS 3 VIEWS BILAT-PBB","code_information":[{"code":"2935176","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"REM OF THIGH LES < 3CM-PBB","code_information":[{"code":"2935177","type":"CDM"},{"code":"361","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"setting":"both","billing_class":"professional"}]},{"description":"CONTROL OF NOSE BLEED-PBB","code_information":[{"code":"2935178","type":"CDM"},{"code":"361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.5,"setting":"both","billing_class":"professional"}]},{"description":"TANGNTL BX SKIN SINGL LES-PBB","code_information":[{"code":"2935179","type":"CDM"},{"code":"361","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"TANGNTL BX SKIN ADDL LES-PBB","code_information":[{"code":"2935180","type":"CDM"},{"code":"361","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"DECLOT VASCULAR DEVICE-PBB","code_information":[{"code":"2935188","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY OF NERVE-PBB","code_information":[{"code":"2935190","type":"CDM"},{"code":"361","type":"RC"},{"code":"64795","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.5,"setting":"both","billing_class":"professional"}]},{"description":"SQ INJ FILLING MATERIAL-PBB","code_information":[{"code":"2935191","type":"CDM"},{"code":"361","type":"RC"},{"code":"11950","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"NEEDLE EMG CRANIAL NRV BIL-PBB","code_information":[{"code":"2935196","type":"CDM"},{"code":"510","type":"RC"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"NEUROP TST BY TECH 1ST 30M-PBB","code_information":[{"code":"2935211","type":"CDM"},{"code":"361","type":"RC"},{"code":"96138","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"NEUROP TST BY TECH ADD 30M-PBB","code_information":[{"code":"2935212","type":"CDM"},{"code":"361","type":"RC"},{"code":"96139","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF RADIUS-PBB","code_information":[{"code":"2935215","type":"CDM"},{"code":"361","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"setting":"both","billing_class":"professional"}]},{"description":"TREAT FX OF ULNA W MANIP-PBB","code_information":[{"code":"2935216","type":"CDM"},{"code":"361","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED ORL SERVICE/PX-PBB","code_information":[{"code":"2935238","type":"CDM"},{"code":"510","type":"RC"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"BINOCULAR VISION EXAM-PBB","code_information":[{"code":"2935239","type":"CDM"},{"code":"510","type":"RC"},{"code":"92060","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"VISUAL FIELD EXAM-PBB","code_information":[{"code":"2935240","type":"CDM"},{"code":"510","type":"RC"},{"code":"92083","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"INTERM VISUAL FIELD EXAM-PBB","code_information":[{"code":"2935241","type":"CDM"},{"code":"510","type":"RC"},{"code":"92082","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 5-6 REGNS-PBB","code_information":[{"code":"2935251","type":"CDM"},{"code":"510","type":"RC"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 7-8 REGNS-PBB","code_information":[{"code":"2935252","type":"CDM"},{"code":"510","type":"RC"},{"code":"98928","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOPATHIC MAN 9-10 REGNS-PBB","code_information":[{"code":"2935253","type":"CDM"},{"code":"510","type":"RC"},{"code":"98929","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"setting":"both","billing_class":"professional"}]},{"description":"ASSMT & CARE PLAN-PBB","code_information":[{"code":"2935271","type":"CDM"},{"code":"510","type":"RC"},{"code":"99483","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"LIMITED VISUAL EXAM-PBB","code_information":[{"code":"2935279","type":"CDM"},{"code":"510","type":"RC"},{"code":"92081","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"CORNEAL TOPOGRAPHY-PBB","code_information":[{"code":"2935280","type":"CDM"},{"code":"510","type":"RC"},{"code":"92025","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"OPHTHALMIC BIOMETRY-PBB","code_information":[{"code":"2935281","type":"CDM"},{"code":"510","type":"RC"},{"code":"92136","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","modifiers":"26","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"EYE EXAM NEW PT-PBB","code_information":[{"code":"2935283","type":"CDM"},{"code":"510","type":"RC"},{"code":"92004","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM NEW PT-PBB","code_information":[{"code":"2935284","type":"CDM"},{"code":"510","type":"RC"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"EYE EXAM & TX-PBB","code_information":[{"code":"2935285","type":"CDM"},{"code":"510","type":"RC"},{"code":"92014","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"INTERM EYE EXAM EST PT-PBB","code_information":[{"code":"2935286","type":"CDM"},{"code":"510","type":"RC"},{"code":"92012","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION-PBB","code_information":[{"code":"2935288","type":"CDM"},{"code":"361","type":"RC"},{"code":"67801","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.75,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION-PBB","code_information":[{"code":"2935289","type":"CDM"},{"code":"361","type":"RC"},{"code":"67805","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"setting":"both","billing_class":"professional"}]},{"description":"EXC CHALAZION,SNGL-PBB","code_information":[{"code":"2935290","type":"CDM"},{"code":"361","type":"RC"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.25,"setting":"both","billing_class":"professional"}]},{"description":"DILATE TEAR DUCT OPENING-PBB","code_information":[{"code":"2935291","type":"CDM"},{"code":"361","type":"RC"},{"code":"68801","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"REM FB CONJUNCTIVA-PBB","code_information":[{"code":"2935292","type":"CDM"},{"code":"361","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"SEVER ADHESIONS-PBB","code_information":[{"code":"2935293","type":"CDM"},{"code":"361","type":"RC"},{"code":"65860","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"LASER SURGERY EYE STRNDS-PBB","code_information":[{"code":"2935295","type":"CDM"},{"code":"361","type":"RC"},{"code":"67031","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"professional"}]},{"description":"FUNDUS PHOTOGRAPHY-PBB","code_information":[{"code":"2935300","type":"CDM"},{"code":"510","type":"RC"},{"code":"92250","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"TREAT HUMERUS FX W/MAN-PBB","code_information":[{"code":"2935320","type":"CDM"},{"code":"361","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND CORNEAL-PBB","code_information":[{"code":"2935321","type":"CDM"},{"code":"320","type":"RC"},{"code":"76514","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"facility"},{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"EXC ARM/ELBOW <3CM-PBB","code_information":[{"code":"2935322","type":"CDM"},{"code":"361","type":"RC"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPI 6/> VW-PBB","code_information":[{"code":"2935323","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY LOWER SPINE-PBB","code_information":[{"code":"2935324","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"AFTER CATARACT LASER SUR-PBB","code_information":[{"code":"2935326","type":"CDM"},{"code":"510","type":"RC"},{"code":"66821","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"professional"}]},{"description":"REVISION OF IRIS LASER-PBB","code_information":[{"code":"2935328","type":"CDM"},{"code":"510","type":"RC"},{"code":"66761","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.25,"setting":"both","billing_class":"professional"}]},{"description":"SUBCONJUNCTIVAL INJ-PBB","code_information":[{"code":"2935329","type":"CDM"},{"code":"510","type":"RC"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"EKG INIT PREVENT INT-PBB","code_information":[{"code":"2935330","type":"CDM"},{"code":"730","type":"RC"},{"code":"G0405","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.25,"setting":"both","billing_class":"professional"}]},{"description":"REM OF ANAL TAG-PBB","code_information":[{"code":"2935331","type":"CDM"},{"code":"361","type":"RC"},{"code":"46220","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY SACROILIAC JNTS-PBB","code_information":[{"code":"2935332","type":"CDM"},{"code":"361","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"CLOSE TEAR DUCT OPENING-PBB","code_information":[{"code":"2935333","type":"CDM"},{"code":"361","type":"RC"},{"code":"68761","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ  OCCIP-PBB","code_information":[{"code":"2935334","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 2 LIMBS-PBB","code_information":[{"code":"2935335","type":"CDM"},{"code":"510","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 3 LIMBS-PBB","code_information":[{"code":"2935336","type":"CDM"},{"code":"510","type":"RC"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"MUSCLE TEST 4 LIMBS-PBB","code_information":[{"code":"2935337","type":"CDM"},{"code":"510","type":"RC"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.5,"setting":"both","billing_class":"professional"}]},{"description":"SLIT LAMP PHOTO-PBB","code_information":[{"code":"2935342","type":"CDM"},{"code":"510","type":"RC"},{"code":"92285","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.25,"setting":"both","billing_class":"professional"}]},{"description":"NEG PRESS WND TX <=50SQ CM-PBB","code_information":[{"code":"2935343","type":"CDM"},{"code":"510","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"TRABECULOPLASTY LASER SURG-PBB","code_information":[{"code":"2935345","type":"CDM"},{"code":"361","type":"RC"},{"code":"65855","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHOGR INJ-PBB","code_information":[{"code":"2935346","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHROGR INJ-PBB","code_information":[{"code":"2935347","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR C/T INJ-PBB","code_information":[{"code":"2935348","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"INTERLAMINAR L/S INJ-PBB","code_information":[{"code":"2935349","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ-PBB","code_information":[{"code":"2935350","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ SNGL LVL-PBB","code_information":[{"code":"2935351","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER INJ EA ADDL LVL-PBB","code_information":[{"code":"2935352","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER II/IH NRV INJ-PBB","code_information":[{"code":"2935353","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.25,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IMG INJ-PBB","code_information":[{"code":"2935354","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER C/T W IM ADD LVL-PBB","code_information":[{"code":"2935355","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S SNGL LVL-PBB","code_information":[{"code":"2935356","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES/STER L/S EA ADDL LVL-PBB","code_information":[{"code":"2935357","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 1 LVL-PBB","code_information":[{"code":"2935358","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 2 LVL-PBB","code_information":[{"code":"2935359","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.75,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PARAV JNT C/T 3 LVL-PBB","code_information":[{"code":"2935360","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 1 LVL-PBB","code_information":[{"code":"2935361","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 2 LVL-PBB","code_information":[{"code":"2935362","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"professional"}]},{"description":"DX/TH PAVAV JNT L/S 3 LVL-PBB","code_information":[{"code":"2935363","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"professional"}]},{"description":"ANES SPHEN GANGL INJ-PBB","code_information":[{"code":"2935364","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"ANES STELL GANGL INJ-PBB","code_information":[{"code":"2935365","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"professional"}]},{"description":"NB HYPOGAS PLXS INJ-PBB","code_information":[{"code":"2935366","type":"CDM"},{"code":"361","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES LMBR/THRC INJ-PBB","code_information":[{"code":"2935367","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES CELIAC PLXS INJ-PBB","code_information":[{"code":"2935368","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT-PBB","code_information":[{"code":"2935369","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST C/T FACET JNT ADDL-PBB","code_information":[{"code":"2935370","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT-PBB","code_information":[{"code":"2935371","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST L/S FACET JNT ADDL-PBB","code_information":[{"code":"2935372","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.5,"setting":"both","billing_class":"professional"}]},{"description":"BLINKI REFLEX TST-PBB","code_information":[{"code":"2935374","type":"CDM"},{"code":"361","type":"RC"},{"code":"95933","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/O PR-PBB","code_information":[{"code":"2935377","type":"CDM"},{"code":"920","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","billing_class":"professional"}]},{"description":"ANALYSIS NEURO STIM W/ PR-PBB","code_information":[{"code":"2935378","type":"CDM"},{"code":"920","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"ALYS NEUROST COMPL W/ PR-PBB","code_information":[{"code":"2935379","type":"CDM"},{"code":"920","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"REM IMPACTED EAR WAX-PBB","code_information":[{"code":"2935380","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.5,"setting":"both","billing_class":"professional"}]},{"description":"EXC CYST/GANGLION TOES-PBB","code_information":[{"code":"2935381","type":"CDM"},{"code":"361","type":"RC"},{"code":"28092","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M SVC 5-10M-PBB","code_information":[{"code":"2935382","type":"CDM"},{"code":"510","type":"RC"},{"code":"99421","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M SVC 11-20M-PBB","code_information":[{"code":"2935383","type":"CDM"},{"code":"510","type":"RC"},{"code":"99422","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"ONLINE DIG E/M 21PBB","code_information":[{"code":"2935384","type":"CDM"},{"code":"510","type":"RC"},{"code":"99423","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOTE EVAL OF IMAGE-PBB","code_information":[{"code":"2935385","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2010","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"BRIEF COMM TECH-BASED SVC-PBB","code_information":[{"code":"2935386","type":"CDM"},{"code":"510","type":"RC"},{"code":"98016","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW LOW 30 MIN-PBB","code_information":[{"code":"2935388","type":"CDM"},{"code":"960","type":"RC"},{"code":"98009","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW MOD 45 MIN-PBB","code_information":[{"code":"2935389","type":"CDM"},{"code":"960","type":"RC"},{"code":"98010","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW SF 15 MIN-PBB","code_information":[{"code":"2935390","type":"CDM"},{"code":"960","type":"RC"},{"code":"98008","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL NEW E/M SF 15MIN-PBB","code_information":[{"code":"2935392","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M LOW 30MIN-PBB","code_information":[{"code":"2935393","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M LEV 1-PBB","code_information":[{"code":"2935394","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL EST E/M SF 10MIN-PBB","code_information":[{"code":"2935395","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M LOW 20MIN-PBB","code_information":[{"code":"2935396","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M MOD 30MIN-PBB","code_information":[{"code":"2935397","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M HIGH 40MIN-PBB","code_information":[{"code":"2935398","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE NEW E/M SF 15MIN-PBB","code_information":[{"code":"2935409","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M LOW 30MIN-PBB","code_information":[{"code":"2935410","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M MOD 45MIN-PBB","code_information":[{"code":"2935411","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M HIGH 60MIN-PBB","code_information":[{"code":"2935412","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.5,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M LEV 1-PBB","code_information":[{"code":"2935413","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE EST E/M SF 10MIN-PBB","code_information":[{"code":"2935414","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.25,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M LOW 20MIN-PBB","code_information":[{"code":"2935415","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M MOD 30MIN-PBB","code_information":[{"code":"2935416","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M HIGH 40MIN-PBB","code_information":[{"code":"2935417","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"VIRTUAL NEW E/M MOD 45MIN-PBB","code_information":[{"code":"2935419","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"LACRIMAL PUNCTA SNIP-PBB","code_information":[{"code":"2935428","type":"CDM"},{"code":"361","type":"RC"},{"code":"68440","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"OPSCPY EXT W/ SCL DEP-PBB","code_information":[{"code":"2935429","type":"CDM"},{"code":"510","type":"RC"},{"code":"92201","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL PREV NEW INFANT-PBB","code_information":[{"code":"2935430","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 1-4YR-PBB","code_information":[{"code":"2935431","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 5-11YR-PBB","code_information":[{"code":"2935432","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 12-17YR-PBB","code_information":[{"code":"2935433","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 18-39YR-PBB","code_information":[{"code":"2935434","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 40-64YR-PBB","code_information":[{"code":"2935435","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV NEW 65PBB","code_information":[{"code":"2935436","type":"CDM"},{"code":"510","type":"RC"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST INFANT-PBB","code_information":[{"code":"2935437","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 1-4YR-PBB","code_information":[{"code":"2935438","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 5-11YR-PBB","code_information":[{"code":"2935439","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 12-17YR-PBB","code_information":[{"code":"2935440","type":"CDM"},{"code":"510","type":"RC"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 18-39YR-PBB","code_information":[{"code":"2935441","type":"CDM"},{"code":"510","type":"RC"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 40-64YR-PBB","code_information":[{"code":"2935442","type":"CDM"},{"code":"510","type":"RC"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL PREV EST 65PBB","code_information":[{"code":"2935443","type":"CDM"},{"code":"510","type":"RC"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL TOB COUNSEL 3-10M-PBB","code_information":[{"code":"2935444","type":"CDM"},{"code":"510","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL TOB COUNSEL >10M-PBB","code_information":[{"code":"2935445","type":"CDM"},{"code":"510","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL QUAL NONMD 5-10M-PBB","code_information":[{"code":"2935446","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2061","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL QUAL NONMD 11-20M-PBB","code_information":[{"code":"2935447","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2062","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL QUAL NONMD  >21M-PBB","code_information":[{"code":"2935448","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2063","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL TCM W/IN 14D-PBB","code_information":[{"code":"2935449","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL TCM W/IN 7D-PBB","code_information":[{"code":"2935450","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"BX SOFT TISSUE THIGH/KNEE-PBB","code_information":[{"code":"2935451","type":"CDM"},{"code":"361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL ANNUAL WLLNSS INIT-PBB","code_information":[{"code":"2935452","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL ANNUAL WLLNSS SBSQ-PBB","code_information":[{"code":"2935453","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NEW E/M HIGH 60MIN-PBB","code_information":[{"code":"2935454","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"POSITIONAL NYSTAGMUS TST-PBB","code_information":[{"code":"2935460","type":"CDM"},{"code":"510","type":"RC"},{"code":"92542","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/O STIM 15M-PBB","code_information":[{"code":"2935464","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97810","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"ACUPUNCT W/O STIM ADDL 15M-PBB","code_information":[{"code":"2935465","type":"CDM"},{"code":"2101","type":"RC"},{"code":"97811","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"setting":"both","billing_class":"professional"}]},{"description":"A-SCAN EYE US W IOL MEASR-PBB","code_information":[{"code":"2935466","type":"CDM"},{"code":"402","type":"RC"},{"code":"76519","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.75,"setting":"both","billing_class":"professional"}]},{"description":"OPSCPY EXT W/O SCL DEP-PBB","code_information":[{"code":"2935467","type":"CDM"},{"code":"510","type":"RC"},{"code":"92202","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP NO REPROGRAM-PBB","code_information":[{"code":"2935468","type":"CDM"},{"code":"361","type":"RC"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REPROGRAM-PBB","code_information":[{"code":"2935469","type":"CDM"},{"code":"361","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL/REPRO-PBB","code_information":[{"code":"2935470","type":"CDM"},{"code":"361","type":"RC"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL-PBB","code_information":[{"code":"2935471","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"CORNEA SCRAPING SMEAR/CUL-PBB","code_information":[{"code":"2935472","type":"CDM"},{"code":"361","type":"RC"},{"code":"65430","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ TRIGEMINAL BIL-PBB","code_information":[{"code":"2935473","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"N BLOCK OTH PERIPHERAL BIL-PBB","code_information":[{"code":"2935474","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"AMNIOTIC GRAFT-PBB","code_information":[{"code":"2935475","type":"CDM"},{"code":"361","type":"RC"},{"code":"65778","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"PARACENTESIS ANT CHAMB-PBB","code_information":[{"code":"2935476","type":"CDM"},{"code":"361","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"BLEPHAROPLASTY UPPER LID-PBB","code_information":[{"code":"2935477","type":"CDM"},{"code":"361","type":"RC"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"setting":"both","billing_class":"professional"}]},{"description":"REM CORNEAL EPI-PBB","code_information":[{"code":"2935478","type":"CDM"},{"code":"361","type":"RC"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.75,"setting":"both","billing_class":"professional"}]},{"description":"EPILATION,FORCEPS-PBB","code_information":[{"code":"2935479","type":"CDM"},{"code":"361","type":"RC"},{"code":"67820","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"REM EYELID LESION-PBB","code_information":[{"code":"2935482","type":"CDM"},{"code":"361","type":"RC"},{"code":"67840","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.75,"setting":"both","billing_class":"professional"}]},{"description":"TENON CAPSULE INJ-PBB","code_information":[{"code":"2935483","type":"CDM"},{"code":"361","type":"RC"},{"code":"67515","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"HARVEST CULTURED SK GRAFT-PBB","code_information":[{"code":"2935490","type":"CDM"},{"code":"361","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJECT JNT/BURSA BIL-PBB","code_information":[{"code":"2935491","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPAIR ENTROPION SUTURE-PBB","code_information":[{"code":"2935492","type":"CDM"},{"code":"361","type":"RC"},{"code":"67921","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY PALATE UVULA-PBB","code_information":[{"code":"2935493","type":"CDM"},{"code":"361","type":"RC"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.25,"setting":"both","billing_class":"professional"}]},{"description":"INSERT HORMONE SQ-PBB","code_information":[{"code":"2935495","type":"CDM"},{"code":"361","type":"RC"},{"code":"11980","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR EXTENSIVE ECTROPIAN-PBB","code_information":[{"code":"2935496","type":"CDM"},{"code":"361","type":"RC"},{"code":"67917","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF PELVIS 3V-PBB","code_information":[{"code":"2935497","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"INC CONJUNCTIVA DRAINAGE-PBB","code_information":[{"code":"2935498","type":"CDM"},{"code":"510","type":"RC"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSC-PBB","code_information":[{"code":"2935499","type":"CDM"},{"code":"361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.25,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE OF BLADDER TUBE-PBB","code_information":[{"code":"2935500","type":"CDM"},{"code":"361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"ANES VIA SPHENO CATH-PBB","code_information":[{"code":"2935504","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"PERC RELEASE DUPUYTREN CON-PBB","code_information":[{"code":"2935515","type":"CDM"},{"code":"361","type":"RC"},{"code":"26040","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"setting":"both","billing_class":"professional"}]},{"description":"ALYS IMPLANT W/PRGRM-PBB","code_information":[{"code":"2935519","type":"CDM"},{"code":"510","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"ALYS CPLX IMPLANT W/PRGRM-PBB","code_information":[{"code":"2935520","type":"CDM"},{"code":"510","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV TRUNK MUSC 1-5-PBB","code_information":[{"code":"2935523","type":"CDM"},{"code":"361","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM HIP-PBB","code_information":[{"code":"2935524","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-PBB","code_information":[{"code":"2935525","type":"CDM"},{"code":"361","type":"RC"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.75,"setting":"both","billing_class":"professional"}]},{"description":"SUTURE WOUND EYELID-PBB","code_information":[{"code":"2935526","type":"CDM"},{"code":"361","type":"RC"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR ENTROPION THERMOCAU-PBB","code_information":[{"code":"2935527","type":"CDM"},{"code":"361","type":"RC"},{"code":"67922","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM BIL HIP-PBB","code_information":[{"code":"2935528","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXPL/TX RADIOCARPAL JNT-PBB","code_information":[{"code":"2935613","type":"CDM"},{"code":"361","type":"RC"},{"code":"25040","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.5,"setting":"both","billing_class":"professional"}]},{"description":"AEP HEARING STATUS DET I&R-PBB","code_information":[{"code":"2936009","type":"CDM"},{"code":"510","type":"RC"},{"code":"92651","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"AEP THRSHLD EST ML FRQ I&R-PBB","code_information":[{"code":"2936010","type":"CDM"},{"code":"510","type":"RC"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"professional"}]},{"description":"AEP NEURODIAGNOSTIC I&R-PBB","code_information":[{"code":"2936011","type":"CDM"},{"code":"510","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"PROLNG OFF/OP E/M EA 15M-PBB","code_information":[{"code":"2936012","type":"CDM"},{"code":"510","type":"RC"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE MGNT 1ST 20M-PBB","code_information":[{"code":"2936013","type":"CDM"},{"code":"510","type":"RC"},{"code":"99490","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.75,"setting":"both","billing_class":"professional"}]},{"description":"CHRNC CARE EA ADDL 20M-PBB","code_information":[{"code":"2936014","type":"CDM"},{"code":"510","type":"RC"},{"code":"99439","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"ADVANCED DIRECTIVE GUIDNCE-PBB","code_information":[{"code":"2936015","type":"CDM"},{"code":"510","type":"RC"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"NB FEMORAL BIL-PBB","code_information":[{"code":"2936016","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-PBB","code_information":[{"code":"2936017","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-PBB","code_information":[{"code":"2936018","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY LOWER LEG BIL-PBB","code_information":[{"code":"2936019","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY ANKLE BILATERAL-PBB","code_information":[{"code":"2936020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REPAIR ENTROPION EXTENSIVE-PBB","code_information":[{"code":"2936022","type":"CDM"},{"code":"361","type":"RC"},{"code":"67924","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY FOOT BILATERAL-PBB","code_information":[{"code":"2936023","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY OF FOOT BIL-PBB","code_information":[{"code":"2936024","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HLTH BHV ASSMT/REASSMT-PBB","code_information":[{"code":"2936026","type":"CDM"},{"code":"361","type":"RC"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV INT J IND 1ST 30-PBB","code_information":[{"code":"2936027","type":"CDM"},{"code":"361","type":"RC"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT INDIV EA ADD-PBB","code_information":[{"code":"2936028","type":"CDM"},{"code":"361","type":"RC"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"setting":"both","billing_class":"professional"}]},{"description":"HLTH HHV IVNT FAM 1ST 30-PBB","code_information":[{"code":"2936029","type":"CDM"},{"code":"361","type":"RC"},{"code":"96167","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNTJ FAM EA ADDL-PBB","code_information":[{"code":"2936030","type":"CDM"},{"code":"361","type":"RC"},{"code":"96168","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM WO PT 1ST-PBB","code_information":[{"code":"2936031","type":"CDM"},{"code":"361","type":"RC"},{"code":"96170","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"HLTH BHV IVNT FM W/O PT EA-PBB","code_information":[{"code":"2936032","type":"CDM"},{"code":"361","type":"RC"},{"code":"96171","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ JOINT/BURSA BIL-PBB","code_information":[{"code":"2936033","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"THER INJ  CARP TUNNEL BIL-PBB","code_information":[{"code":"2936034","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CYSTO W FRAGM OF CALCULUS-PBB","code_information":[{"code":"2936035","type":"CDM"},{"code":"361","type":"RC"},{"code":"52325","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY ENTIRE SPINE 4/5 VW-PBB","code_information":[{"code":"2936036","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODEN MUSC NECK BIL-PBB","code_information":[{"code":"2936037","type":"CDM"},{"code":"361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY EXAM SPI 1 VW-PBB","code_information":[{"code":"2936038","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"professional"}]},{"description":"NJX INTERLAMINAR LMBR/SAC-PBB","code_information":[{"code":"2936599","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.5,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEX DRAINAGE WND-PBB","code_information":[{"code":"2937001","type":"CDM"},{"code":"361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE TISSUE MUSC-PBB","code_information":[{"code":"2937002","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE 20CM OR LESS-PBB","code_information":[{"code":"2937003","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"setting":"both","billing_class":"professional"}]},{"description":"INCAL BX SKN SINGLE LES-PBB","code_information":[{"code":"2937006","type":"CDM"},{"code":"361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.5,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 1.1-5.0CC-PBB","code_information":[{"code":"2937011","type":"CDM"},{"code":"361","type":"RC"},{"code":"11951","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"professional"}]},{"description":"SQ COLLAGEN; 5.1-10.0 CC-PBB","code_information":[{"code":"2937012","type":"CDM"},{"code":"361","type":"RC"},{"code":"11952","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.5,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP ADDL 100 CM-PBB","code_information":[{"code":"2937014","type":"CDM"},{"code":"361","type":"RC"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.75,"setting":"both","billing_class":"professional"}]},{"description":"WND F/N/HF/G 100 SQCM/1%BA-PBB","code_information":[{"code":"2937015","type":"CDM"},{"code":"361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE BX OPEN SUPERFICIAL-PBB","code_information":[{"code":"2937016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.5,"setting":"both","billing_class":"professional"}]},{"description":"I & D INFECTED BURSA  FOOT-PBB","code_information":[{"code":"2937018","type":"CDM"},{"code":"361","type":"RC"},{"code":"28001","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.5,"setting":"both","billing_class":"professional"}]},{"description":"DEEP DIS FT INF SGL BURSA-PBB","code_information":[{"code":"2937019","type":"CDM"},{"code":"361","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.5,"setting":"both","billing_class":"professional"}]},{"description":"DEEP I&D FT INF MULTI AREA-PBB","code_information":[{"code":"2937020","type":"CDM"},{"code":"361","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"setting":"both","billing_class":"professional"}]},{"description":"DEEP INC FT W OP BONE CRTX-PBB","code_information":[{"code":"2937021","type":"CDM"},{"code":"361","type":"RC"},{"code":"28005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISE FOOT/TOE FASCIA-PBB","code_information":[{"code":"2937022","type":"CDM"},{"code":"361","type":"RC"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"setting":"both","billing_class":"professional"}]},{"description":"TENOTOMY SQ TOE; SINGLE-PBB","code_information":[{"code":"2937023","type":"CDM"},{"code":"361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.75,"setting":"both","billing_class":"professional"}]},{"description":"REM DEEP FB OF FOOT-PBB","code_information":[{"code":"2937024","type":"CDM"},{"code":"361","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.5,"setting":"both","billing_class":"professional"}]},{"description":"TENTMY OP FLEX FT SGL/MULT-PBB","code_information":[{"code":"2937025","type":"CDM"},{"code":"361","type":"RC"},{"code":"28230","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.25,"setting":"both","billing_class":"professional"}]},{"description":"MTP JNT CAPSULO EA SGL JNT-PBB","code_information":[{"code":"2937026","type":"CDM"},{"code":"361","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.25,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION HALLUX VALGUS-PBB","code_information":[{"code":"2937027","type":"CDM"},{"code":"361","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"CL TX MTP JNT DISLC W ANES-PBB","code_information":[{"code":"2937028","type":"CDM"},{"code":"361","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.5,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JNT DISLC WO ANES-PBB","code_information":[{"code":"2937029","type":"CDM"},{"code":"361","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.5,"setting":"both","billing_class":"professional"}]},{"description":"CL TX IP JOINT DISL W ANES-PBB","code_information":[{"code":"2937030","type":"CDM"},{"code":"361","type":"RC"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING OF TOES-PBB","code_information":[{"code":"2937031","type":"CDM"},{"code":"361","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"N BLOCK INJ COMMON DIGIT-PBB","code_information":[{"code":"2937032","type":"CDM"},{"code":"361","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"DECOM PLANTAR DIGITAL NERV-PBB","code_information":[{"code":"2937034","type":"CDM"},{"code":"361","type":"RC"},{"code":"64726","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND LMT JT-PBB","code_information":[{"code":"2937035","type":"CDM"},{"code":"361","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"PROLONG OUTPT/OFFICE VIS-PBB","code_information":[{"code":"2937040","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"}]},{"description":"INC MULTI SQ TOE TENDONS-PBB","code_information":[{"code":"2937042","type":"CDM"},{"code":"361","type":"RC"},{"code":"28011","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.75,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY NAIL UNIT-PBB","code_information":[{"code":"2937045","type":"CDM"},{"code":"361","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 1.1-2.5 CM-PBB","code_information":[{"code":"2937046","type":"CDM"},{"code":"361","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.75,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L ADDL 5CM/<-PBB","code_information":[{"code":"2937047","type":"CDM"},{"code":"361","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN PINCH GRAFT-PBB","code_information":[{"code":"2937048","type":"CDM"},{"code":"361","type":"RC"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1094.5,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-PBB","code_information":[{"code":"2937049","type":"CDM"},{"code":"361","type":"RC"},{"code":"15241","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.75,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT ADD-ON-PBB","code_information":[{"code":"2937050","type":"CDM"},{"code":"361","type":"RC"},{"code":"15261","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.75,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-PBB","code_information":[{"code":"2937051","type":"CDM"},{"code":"361","type":"RC"},{"code":"17270","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"professional"}]},{"description":"S/N/H/F/G LES DIAM>4.0 CM-PBB","code_information":[{"code":"2937052","type":"CDM"},{"code":"361","type":"RC"},{"code":"17276","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.25,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE H/N/HF/G-PBB","code_information":[{"code":"2937053","type":"CDM"},{"code":"361","type":"RC"},{"code":"17311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.25,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE-PBB","code_information":[{"code":"2937054","type":"CDM"},{"code":"361","type":"RC"},{"code":"17312","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.5,"setting":"both","billing_class":"professional"}]},{"description":"MOHS 1 STAGE T/A/L-PBB","code_information":[{"code":"2937055","type":"CDM"},{"code":"361","type":"RC"},{"code":"17313","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS ADDL STAGE T/A/L-PBB","code_information":[{"code":"2937056","type":"CDM"},{"code":"361","type":"RC"},{"code":"17314","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"setting":"both","billing_class":"professional"}]},{"description":"MOHS SURG ADDL BLOCK-PBB","code_information":[{"code":"2937057","type":"CDM"},{"code":"361","type":"RC"},{"code":"17315","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"DEBRIDE BONE EACH ADDL-PBB","code_information":[{"code":"2937139","type":"CDM"},{"code":"361","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.75,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 1.1-2.5 CM-PBB","code_information":[{"code":"2937140","type":"CDM"},{"code":"361","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.5,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK 2.6-7.5 CM-PBB","code_information":[{"code":"2937141","type":"CDM"},{"code":"361","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"professional"}]},{"description":"TRUNK EA ADDL 5CM/<-PBB","code_information":[{"code":"2937142","type":"CDM"},{"code":"361","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.5,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 1.1-2.5 CM-PBB","code_information":[{"code":"2937143","type":"CDM"},{"code":"361","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG 2.6-7.5 CM-PBB","code_information":[{"code":"2937144","type":"CDM"},{"code":"361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.75,"setting":"both","billing_class":"professional"}]},{"description":"SCALP/ARM/LEG EA ADL 5 CM<-PBB","code_information":[{"code":"2937145","type":"CDM"},{"code":"361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F1.1-2.5CM-PBB","code_information":[{"code":"2937146","type":"CDM"},{"code":"361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.25,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F2.6-7.5CM-PBB","code_information":[{"code":"2937147","type":"CDM"},{"code":"361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.5,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F AD 5CM<-PBB","code_information":[{"code":"2937148","type":"CDM"},{"code":"361","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"setting":"both","billing_class":"professional"}]},{"description":"RPR E/N/E/L 2.6-7.5 CM-PBB","code_information":[{"code":"2937150","type":"CDM"},{"code":"361","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.5,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<-PBB","code_information":[{"code":"2937151","type":"CDM"},{"code":"361","type":"RC"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR TUNK 10.1-30SQCM-PBB","code_information":[{"code":"2937152","type":"CDM"},{"code":"361","type":"RC"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.25,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<-PBB","code_information":[{"code":"2937153","type":"CDM"},{"code":"361","type":"RC"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.5,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR S/A/L10.1-30SQCM-PBB","code_information":[{"code":"2937154","type":"CDM"},{"code":"361","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.75,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/A/G/H/F 10SQCM/<-PBB","code_information":[{"code":"2937155","type":"CDM"},{"code":"361","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.75,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F 10.1-30-PBB","code_information":[{"code":"2937156","type":"CDM"},{"code":"361","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.75,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR E/N/E/L 10 SQCM<-PBB","code_information":[{"code":"2937157","type":"CDM"},{"code":"361","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.25,"setting":"both","billing_class":"professional"}]},{"description":"TRNFR E/N/E/L10.1-30SQCM-PBB","code_information":[{"code":"2937158","type":"CDM"},{"code":"361","type":"RC"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.5,"setting":"both","billing_class":"professional"}]},{"description":"F/C/C/M/N/AX/G/H/F 20 CM/<-PBB","code_information":[{"code":"2937159","type":"CDM"},{"code":"361","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1732.0,"setting":"both","billing_class":"professional"}]},{"description":"SKIN FULL GRAFT EEN & LIPS-PBB","code_information":[{"code":"2937160","type":"CDM"},{"code":"361","type":"RC"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SK LES-PBB","code_information":[{"code":"2937161","type":"CDM"},{"code":"361","type":"RC"},{"code":"17271","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-PBB","code_information":[{"code":"2937162","type":"CDM"},{"code":"361","type":"RC"},{"code":"17272","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.5,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 2.1-3.0CM-PBB","code_information":[{"code":"2937163","type":"CDM"},{"code":"361","type":"RC"},{"code":"17273","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.25,"setting":"both","billing_class":"professional"}]},{"description":"LESION S/N/H/F/G 3.1-4.0CM-PBB","code_information":[{"code":"2937164","type":"CDM"},{"code":"361","type":"RC"},{"code":"17274","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.25,"setting":"both","billing_class":"professional"}]},{"description":"WOUND PREP TRK/ARM/LEG-PBB","code_information":[{"code":"2937165","type":"CDM"},{"code":"361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCTION OF SKIN LES-PBB","code_information":[{"code":"2937166","type":"CDM"},{"code":"361","type":"RC"},{"code":"17280","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 1.1-2.0CM-PBB","code_information":[{"code":"2937167","type":"CDM"},{"code":"361","type":"RC"},{"code":"17282","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"setting":"both","billing_class":"professional"}]},{"description":"LES F/E/E/N/L/M 2.1-3.0CM-PBB","code_information":[{"code":"2937168","type":"CDM"},{"code":"361","type":"RC"},{"code":"17283","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO INTRALESIONL UP TO 7-PBB","code_information":[{"code":"2937169","type":"CDM"},{"code":"331","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-CERVICAL-PBB","code_information":[{"code":"2937170","type":"CDM"},{"code":"361","type":"RC"},{"code":"58321","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTIF INSEM INTRA-UTERINE-PBB","code_information":[{"code":"2937171","type":"CDM"},{"code":"361","type":"RC"},{"code":"58322","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ANY 30.1-60 SQCM-PBB","code_information":[{"code":"2937172","type":"CDM"},{"code":"361","type":"RC"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2029.0,"setting":"both","billing_class":"professional"}]},{"description":"TIS TRNFR ADDL 30 SQ CM-PBB","code_information":[{"code":"2937173","type":"CDM"},{"code":"361","type":"RC"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"setting":"both","billing_class":"professional"}]},{"description":"WND PREP F/N/HF/G ADDL CM-PBB","code_information":[{"code":"2937174","type":"CDM"},{"code":"361","type":"RC"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.5,"setting":"both","billing_class":"professional"}]},{"description":"DESTRUCT MAL LES F/E/E/N-PBB","code_information":[{"code":"2937175","type":"CDM"},{"code":"361","type":"RC"},{"code":"17284","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.25,"setting":"both","billing_class":"professional"}]},{"description":"MAL LESF/E/E/N/L/M >4.0 CM-PBB","code_information":[{"code":"2937176","type":"CDM"},{"code":"361","type":"RC"},{"code":"17286","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV ECCRINE GLANDS-PBB","code_information":[{"code":"2937179","type":"CDM"},{"code":"361","type":"RC"},{"code":"64650","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.5,"setting":"both","billing_class":"professional"}]},{"description":"CHMDENRV ECRINE GLANDS OTH-PBB","code_information":[{"code":"2937180","type":"CDM"},{"code":"361","type":"RC"},{"code":"64653","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"professional"}]},{"description":"ELECT CURRENT THERAPY-PBB","code_information":[{"code":"2937182","type":"CDM"},{"code":"940","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"TX CONTOUR DEFECTS>10.0 CC-PBB","code_information":[{"code":"2937183","type":"CDM"},{"code":"361","type":"RC"},{"code":"11954","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"setting":"both","billing_class":"professional"}]},{"description":"REM FOREIGN BODY FOOT COMP-PBB","code_information":[{"code":"2937184","type":"CDM"},{"code":"361","type":"RC"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF TOE DISLOCATION-PBB","code_information":[{"code":"2937187","type":"CDM"},{"code":"361","type":"RC"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.25,"setting":"both","billing_class":"professional"}]},{"description":"TRIMMING NAILS-PBB","code_information":[{"code":"2937188","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"STRAPPING UNNA BOOT BIL-PBB","code_information":[{"code":"2937189","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRAIN OUTER EAR CANAL LESN-PBB","code_information":[{"code":"2937191","type":"CDM"},{"code":"361","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISE/DRAIN TEAR SAC-PBB","code_information":[{"code":"2937192","type":"CDM"},{"code":"361","type":"RC"},{"code":"68420","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.75,"setting":"both","billing_class":"professional"}]},{"description":"XRAY THORACIC SPINE 4/>VW-PBB","code_information":[{"code":"2937194","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON SHEATH/LIG BIL-PBB","code_information":[{"code":"2937195","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DSTRJ NULYT AGT GNCLR NRV-PBB","code_information":[{"code":"2937196","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.5,"setting":"both","billing_class":"professional"}]},{"description":"REPAIR OF URETHRA INJURY-PBB","code_information":[{"code":"2937197","type":"CDM"},{"code":"361","type":"RC"},{"code":"53502","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.75,"setting":"both","billing_class":"professional"}]},{"description":"LAPARO-MYOMECTOMY COMPLEX-PBB","code_information":[{"code":"2937198","type":"CDM"},{"code":"361","type":"RC"},{"code":"58546","type":"HCPCS"}],"standard_charges":[{"gross_charge":2097.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOCERV CURETTAGE W/SCOPE-PBB","code_information":[{"code":"2937199","type":"CDM"},{"code":"361","type":"RC"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST COMPLETE BIL-PBB","code_information":[{"code":"2937200","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"CLOSED TX VERT FX W/MANJ-PBB","code_information":[{"code":"2937201","type":"CDM"},{"code":"361","type":"RC"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL INTRANASAL LES INT-PBB","code_information":[{"code":"2937204","type":"CDM"},{"code":"361","type":"RC"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":1707.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL INTRANASAL LES EXT-PBB","code_information":[{"code":"2937205","type":"CDM"},{"code":"361","type":"RC"},{"code":"30118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.25,"setting":"both","billing_class":"professional"}]},{"description":"LAPAROSCOPY SALPINGOSTOMY-PBB","code_information":[{"code":"2937208","type":"CDM"},{"code":"361","type":"RC"},{"code":"58673","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE SHOULDER FORGN BODY-PBB","code_information":[{"code":"2937209","type":"CDM"},{"code":"361","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.25,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ JNT/BURSA BIL W/US-PBB","code_information":[{"code":"2937210","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"LAPARO PROC ABDM/PER/OMENT-PBB","code_information":[{"code":"2937211","type":"CDM"},{"code":"361","type":"RC"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY OF HAND BIL-PBB","code_information":[{"code":"2937216","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TREATMENT OF MOUTH LESION-PBB","code_information":[{"code":"2937222","type":"CDM"},{"code":"361","type":"RC"},{"code":"40820","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.25,"setting":"both","billing_class":"professional"}]},{"description":"INJECTION TREATMENT OF EYE-PBB","code_information":[{"code":"2937224","type":"CDM"},{"code":"510","type":"RC"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.5,"setting":"both","billing_class":"professional"}]},{"description":"INCISION OF TOE TENDON-PBB","code_information":[{"code":"2937226","type":"CDM"},{"code":"361","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.75,"setting":"both","billing_class":"professional"}]},{"description":"PRQ IMPLTJ NEUROSTIMULATOR-PBB","code_information":[{"code":"2937237","type":"CDM"},{"code":"361","type":"RC"},{"code":"64555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3925.25,"setting":"both","billing_class":"professional"}]},{"description":"DESTROY NERVE  FACE MC BIL-PBB","code_information":[{"code":"2937239","type":"CDM"},{"code":"361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 4 OR MORE BIL-PBB","code_information":[{"code":"2937240","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"EXHALED NITRIC OXIDE MEAS-PBB","code_information":[{"code":"2937241","type":"CDM"},{"code":"361","type":"RC"},{"code":"95012","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.25,"setting":"both","billing_class":"professional"}]},{"description":"CORRECTION OF ASTIGMATISM-PBB","code_information":[{"code":"2937256","type":"CDM"},{"code":"361","type":"RC"},{"code":"65772","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.5,"setting":"both","billing_class":"professional"}]},{"description":"DSTRJ NEUROLYTIC AGENT NRV-PBB","code_information":[{"code":"2937257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.75,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 14 DAY DIS-PBB","code_information":[{"code":"2937258","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.25,"setting":"both","billing_class":"professional"}]},{"description":"TRANS CARE MGMT 7 DAY DIS-PBB","code_information":[{"code":"2937259","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"setting":"both","billing_class":"professional"}]},{"description":"APPLY RIGID LEG CASTS-PBB","code_information":[{"code":"2937262","type":"CDM"},{"code":"361","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS W/IMAGING-PBB","code_information":[{"code":"2937263","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"setting":"both","billing_class":"professional"}]},{"description":"THORACENTESIS WO/IMAGING-PBB","code_information":[{"code":"2937264","type":"CDM"},{"code":"361","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.75,"setting":"both","billing_class":"professional"}]},{"description":"INSRT DRUG DEVICE-PBB","code_information":[{"code":"2937272","type":"CDM"},{"code":"361","type":"RC"},{"code":"68841","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL SUTURE OR STAPLE-PBB","code_information":[{"code":"2937275","type":"CDM"},{"code":"361","type":"RC"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL SUTURE AND STAPLE-PBB","code_information":[{"code":"2937276","type":"CDM"},{"code":"361","type":"RC"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM ANKLE LT-PBB","code_information":[{"code":"2937277","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM ANKLE RT-PBB","code_information":[{"code":"2937278","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"INJECT INTRALESIONAL =<7-PCF","code_information":[{"code":"2950010","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.25,"setting":"both","billing_class":"facility"}]},{"description":"CARPAL TUNNEL INJ-PCF","code_information":[{"code":"2950011","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ TENDON SHEATH/LIGAMENT-PCF","code_information":[{"code":"2950012","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ TENDON ORIGIN/INSERT-PCF","code_information":[{"code":"2950013","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 1/2 MUSCL-PCF","code_information":[{"code":"2950014","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 3 MUSCL-PCF","code_information":[{"code":"2950015","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ SM JNT/BURSA BIL-PCF","code_information":[{"code":"2950016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ SM JNT/BURSA-PCF","code_information":[{"code":"2950017","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ MED JNT/BURS BIL-PCF","code_information":[{"code":"2950018","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ MED JNT/BURSA-PCF","code_information":[{"code":"2950019","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ LG JNT/BURSA BIL-PCF","code_information":[{"code":"2950020","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ LG JNT/BURSA-PCF","code_information":[{"code":"2950021","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ASPIRATE/INJ GANGLION CYST-PCF","code_information":[{"code":"2950022","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"PUNCTURE SHNT/RSVR FOR ASP-PCF","code_information":[{"code":"2950023","type":"CDM"},{"code":"361","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"LYSIS OF EPIDURAL ADHESION-PCF","code_information":[{"code":"2950024","type":"CDM"},{"code":"361","type":"RC"},{"code":"62264","type":"HCPCS"}],"standard_charges":[{"gross_charge":3250.5,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL PUNCTURE,LUMBAR-PCF","code_information":[{"code":"2950025","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"DRN CEREBRO SPINAL FLUID-PCF","code_information":[{"code":"2950026","type":"CDM"},{"code":"361","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL BLOOD PATCH-PCF","code_information":[{"code":"2950027","type":"CDM"},{"code":"361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL CORD LESION SUBR TX-PCF","code_information":[{"code":"2950028","type":"CDM"},{"code":"361","type":"RC"},{"code":"62280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.25,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL CORD LES CER/TH TX-PCF","code_information":[{"code":"2950029","type":"CDM"},{"code":"361","type":"RC"},{"code":"62281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ NEUROL;EPID LUMB/CAUD-PCF","code_information":[{"code":"2950030","type":"CDM"},{"code":"361","type":"RC"},{"code":"62282","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.25,"setting":"both","billing_class":"facility"}]},{"description":"DISKECTOMY,PERCUTANEOUS-PCF","code_information":[{"code":"2950031","type":"CDM"},{"code":"361","type":"RC"},{"code":"62287","type":"HCPCS"}],"standard_charges":[{"gross_charge":15622.0,"setting":"both","billing_class":"facility"}]},{"description":"INJ DISK LESION-PCF","code_information":[{"code":"2950032","type":"CDM"},{"code":"361","type":"RC"},{"code":"62292","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ SPINAL ARTERY-PCF","code_information":[{"code":"2950033","type":"CDM"},{"code":"361","type":"RC"},{"code":"62294","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.25,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ CRV/THO W/O I-PCF","code_information":[{"code":"2950034","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ CRV/THO W/IMA-PCF","code_information":[{"code":"2950035","type":"CDM"},{"code":"361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ LUM/SAC W/O I-PCF","code_information":[{"code":"2950036","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.25,"setting":"both","billing_class":"facility"}]},{"description":"EPI STER INJ LUMB/SAC W/I-PCF","code_information":[{"code":"2950037","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"IMPL DRG PUMP REPROGRAM-PCF","code_information":[{"code":"2950038","type":"CDM"},{"code":"361","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.5,"setting":"both","billing_class":"facility"}]},{"description":"IMPL DRG PUMP REFILL/REPRO-PCF","code_information":[{"code":"2950039","type":"CDM"},{"code":"361","type":"RC"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.5,"setting":"both","billing_class":"facility"}]},{"description":"SCS IMPLNT NEUROSTIMULATOR-PCF","code_information":[{"code":"2950040","type":"CDM"},{"code":"361","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":17293.5,"setting":"both","billing_class":"facility"}]},{"description":"REMOVE NEURO ELECTRD LEADS-PCF","code_information":[{"code":"2950041","type":"CDM"},{"code":"361","type":"RC"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.25,"setting":"both","billing_class":"facility"}]},{"description":"REV SPINE ELTR PERQ ARAY-PCF","code_information":[{"code":"2950042","type":"CDM"},{"code":"361","type":"RC"},{"code":"63663","type":"HCPCS"}],"standard_charges":[{"gross_charge":21616.5,"setting":"both","billing_class":"facility"}]},{"description":"NEURORECVR STIMUL INSERT-PCF","code_information":[{"code":"2950043","type":"CDM"},{"code":"361","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":101763.5,"setting":"both","billing_class":"facility"}]},{"description":"REV/REMOVE NEURORECVR-PCF","code_information":[{"code":"2950044","type":"CDM"},{"code":"361","type":"RC"},{"code":"63688","type":"HCPCS"}],"standard_charges":[{"gross_charge":10123.75,"setting":"both","billing_class":"facility"}]},{"description":"NB SUPRAORBITAL AREA-PCF","code_information":[{"code":"2950045","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"NB OCCIPITAL BIL-PCF","code_information":[{"code":"2950047","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB OCCIPITAL LT-PCF","code_information":[{"code":"2950048","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB OCCIPITAL RT-PCF","code_information":[{"code":"2950049","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB VAGUS INJ-PCF","code_information":[{"code":"2950050","type":"CDM"},{"code":"361","type":"RC"},{"code":"64408","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"NB INTERSC/BRACH PLEX BIL-PCF","code_information":[{"code":"2950054","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":3607.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB INTERSC/BRACH PLEX LT-PCF","code_information":[{"code":"2950055","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB INTERSC/BRACH PLEX RT-PCF","code_information":[{"code":"2950056","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB AXILLARY BIL-PCF","code_information":[{"code":"2950057","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":3607.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB AXILLARY LT-PCF","code_information":[{"code":"2950058","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB AXILLARY RT-PCF","code_information":[{"code":"2950059","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB SUPRASCAPULAR BIL-PCF","code_information":[{"code":"2950060","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB SUPRASCAPULAR LT-PCF","code_information":[{"code":"2950061","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB SUPRASCAPULAR RT-PCF","code_information":[{"code":"2950062","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB INTERCOSTAL SINGLE-PCF","code_information":[{"code":"2950063","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"NB INTERCOSTAL MULTIPLE-PCF","code_information":[{"code":"2950064","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NB ILIOINGUIN/ILOHYPOGAST-PCF","code_information":[{"code":"2950065","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"NB PUDENDAL INJ-PCF","code_information":[{"code":"2950066","type":"CDM"},{"code":"361","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NB SCIATIC BIL-PCF","code_information":[{"code":"2950067","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB SCIATIC LT-PCF","code_information":[{"code":"2950068","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB SCIATIC RT-PCF","code_information":[{"code":"2950069","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB FEMORAL BIL-PCF","code_information":[{"code":"2950070","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-PCF","code_information":[{"code":"2950071","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-PCF","code_information":[{"code":"2950072","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB OTHER PERIPHERAL-PCF","code_information":[{"code":"2950073","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"TRANSF EPI INJ C/T BIL-PCF","code_information":[{"code":"2950074","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ C/T LT-PCF","code_information":[{"code":"2950075","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T RT-PCF","code_information":[{"code":"2950076","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD LT-PCF","code_information":[{"code":"2950077","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD RT-PCF","code_information":[{"code":"2950078","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 LT-PCF","code_information":[{"code":"2950079","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 RT-PCF","code_information":[{"code":"2950080","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 BI-PCF","code_information":[{"code":"2950081","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ L/SAC A RT-PCF","code_information":[{"code":"2950082","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A LT-PCF","code_information":[{"code":"2950083","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A BI-PCF","code_information":[{"code":"2950084","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1718.5,"setting":"both","billing_class":"facility"}]},{"description":"FACET CER/THORA LEV 1 BIL-PCF","code_information":[{"code":"2950085","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA LEV 1 RT-PCF","code_information":[{"code":"2950086","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA LEV 1 LT-PCF","code_information":[{"code":"2950087","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THOR L2 ADD BIL-PCF","code_information":[{"code":"2950088","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THOR L2 ADD RT-PCF","code_information":[{"code":"2950089","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THOR L2 ADD LT-PCF","code_information":[{"code":"2950090","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THORA NB L3 BIL-PCF","code_information":[{"code":"2950091","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA NB L3 RT-PCF","code_information":[{"code":"2950092","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA NB L3 LT-PCF","code_information":[{"code":"2950093","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1  LT-PCF","code_information":[{"code":"2950094","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 RT-PCF","code_information":[{"code":"2950095","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SACRAL LI BIL-PCF","code_information":[{"code":"2950096","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L2 ADDL RT-PCF","code_information":[{"code":"2950097","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL LT-PCF","code_information":[{"code":"2950098","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL BIL-PCF","code_information":[{"code":"2950099","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L3 ADDL RT-PCF","code_information":[{"code":"2950100","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL LT-PCF","code_information":[{"code":"2950101","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL BIL-PCF","code_information":[{"code":"2950102","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.75,"setting":"both","billing_class":"facility"}]},{"description":"SPHENOPALATINE GANGLION BL-PCF","code_information":[{"code":"2950103","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"NB STELLATE GANGLION BIL-PCF","code_information":[{"code":"2950104","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3607.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB STELLATE GANGLION LT-PCF","code_information":[{"code":"2950105","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB STELLATE GANGLIOM RT-PCF","code_information":[{"code":"2950106","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HYPOGASTRIC PLEXUS BLOCK-PCF","code_information":[{"code":"2950107","type":"CDM"},{"code":"361","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"SYMPATHET BL THO/LUMB/CAUD-PCF","code_information":[{"code":"2950108","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NB CELIAC PEL INJ-PCF","code_information":[{"code":"2950109","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"DEST W NEUROL TRIGEM NERVE-PCF","code_information":[{"code":"2950110","type":"CDM"},{"code":"361","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMODENERV MUSC MIGRAINE-PCF","code_information":[{"code":"2950111","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.5,"setting":"both","billing_class":"facility"}]},{"description":"DEST W NEROL INTERCOST NRV-PCF","code_information":[{"code":"2950112","type":"CDM"},{"code":"361","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NERVE TX INJ OF PUDENDA-PCF","code_information":[{"code":"2950113","type":"CDM"},{"code":"361","type":"RC"},{"code":"64630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"MORTON NEUROMA INJECTION-PCF","code_information":[{"code":"2950114","type":"CDM"},{"code":"361","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.5,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERTEBRAL NRV CT-PCF","code_information":[{"code":"2950115","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":6347.75,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT NRV CT BIL-PCF","code_information":[{"code":"2950116","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":9289.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL BIL-PCF","code_information":[{"code":"2950117","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL-PCF","code_information":[{"code":"2950118","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2416.25,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT NRV L/S-PCF","code_information":[{"code":"2950119","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6347.75,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT NRV L/S BIL-PCF","code_information":[{"code":"2950120","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":9289.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT N ADDL-PCF","code_information":[{"code":"2950121","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":2416.25,"setting":"both","billing_class":"facility"}]},{"description":"DEST PARAVERT N ADDL BIL-PCF","code_information":[{"code":"2950122","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NEUROLYSIS LUMBAR-PCF","code_information":[{"code":"2950123","type":"CDM"},{"code":"361","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NRV TX INJ OF CELIAC PLEX-PCF","code_information":[{"code":"2950124","type":"CDM"},{"code":"361","type":"RC"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"setting":"both","billing_class":"facility"}]},{"description":"NERVE DECOMPRESSION-PCF","code_information":[{"code":"2950125","type":"CDM"},{"code":"361","type":"RC"},{"code":"64722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.25,"setting":"both","billing_class":"facility"}]},{"description":"NERVOUS SYSTEM UNLIST PROC-PCF","code_information":[{"code":"2950126","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"RETROBULBAR INJECTION-PCF","code_information":[{"code":"2950127","type":"CDM"},{"code":"361","type":"RC"},{"code":"67500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.5,"setting":"both","billing_class":"facility"}]},{"description":"DISCOGRAPHY CERV/THOR-PCF","code_information":[{"code":"2950128","type":"CDM"},{"code":"320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.25,"setting":"both","billing_class":"facility"}]},{"description":"DISCOGRAPHY LUMBAR-PCF","code_information":[{"code":"2950129","type":"CDM"},{"code":"320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.25,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROSCOPE UP TO 1 HR-PCF","code_information":[{"code":"2950130","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.75,"setting":"both","billing_class":"facility"}]},{"description":"US GUIDANCE INJECT PLACEM-PCF","code_information":[{"code":"2950131","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO LOCALIZATION-PCF","code_information":[{"code":"2950132","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO GUIDE&LOCAL-PCF","code_information":[{"code":"2950133","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.75,"setting":"both","billing_class":"facility"}]},{"description":"ANALYZE NEUROSTIM NO PROGR-PCF","code_information":[{"code":"2950134","type":"CDM"},{"code":"920","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.75,"setting":"both","billing_class":"facility"}]},{"description":"ANALYZE NEUROSTIM SIMPLE-PCF","code_information":[{"code":"2950135","type":"CDM"},{"code":"920","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.25,"setting":"both","billing_class":"facility"}]},{"description":"IMPL DRG PUMP REFILL-PCF","code_information":[{"code":"2950136","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.25,"setting":"both","billing_class":"facility"}]},{"description":"IV THERAPY DIAG 1ST HR-PCF","code_information":[{"code":"2950137","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility"}]},{"description":"INJECTION THER/PROPH/DIAG-PCF","code_information":[{"code":"2950138","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-PCF","code_information":[{"code":"2950139","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ADMIN INTO CNS-PCF","code_information":[{"code":"2950140","type":"CDM"},{"code":"331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.75,"setting":"both","billing_class":"facility"}]},{"description":"OMT 1-2 BODY REGIONS-PCF","code_information":[{"code":"2950141","type":"CDM"},{"code":"530","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 2 VISIT NEW PT-PCF","code_information":[{"code":"2950143","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 3 VISIT NEW PT-PCF","code_information":[{"code":"2950144","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 4 VISIT NEW PT-PCF","code_information":[{"code":"2950145","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 5 VISIT NEW PT-PCF","code_information":[{"code":"2950146","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 1 VISIT EST PT-PCF","code_information":[{"code":"2950147","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 2 VISIT EST PT-PCF","code_information":[{"code":"2950148","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 3 VISIT EST PT-PCF","code_information":[{"code":"2950149","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 4 VISIT EST PT-PCF","code_information":[{"code":"2950150","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 5 VISIT EST PT-PCF","code_information":[{"code":"2950151","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"setting":"both","billing_class":"facility"}]},{"description":"MINIMALY INV LAMIN DECOM-PCF","code_information":[{"code":"2950152","type":"CDM"},{"code":"361","type":"RC"},{"code":"0275T","type":"HCPCS"}],"standard_charges":[{"gross_charge":17911.5,"setting":"both","billing_class":"facility"}]},{"description":"SCS 2 LEAD KIT ST JUDE-PCF","code_information":[{"code":"2950158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2989.0,"setting":"both","billing_class":"facility"}]},{"description":"SCS LEAD BOSTON SC-PCF","code_information":[{"code":"2950159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2989.0,"setting":"both","billing_class":"facility"}]},{"description":"SACROILIAC JT INJ BIL-PCF","code_information":[{"code":"2950160","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ RT-PCF","code_information":[{"code":"2950161","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ LT-PCF","code_information":[{"code":"2950162","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SCS 2 CBLE/PT KIT ST JUDE-PCF","code_information":[{"code":"2950167","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1060.5,"setting":"both","billing_class":"facility"}]},{"description":"SCS PATIENT KIT BOSTON SC-PCF","code_information":[{"code":"2950170","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":528.5,"setting":"both","billing_class":"facility"}]},{"description":"SCS CABLE BOSTON SC-PCF","code_information":[{"code":"2950172","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility"}]},{"description":"CAPNOGRAPHY EQUIP-PCF","code_information":[{"code":"2950174","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":229.25,"setting":"both","billing_class":"facility"}]},{"description":"SCS 1 LEAD KIT ST JUDE-PCF","code_information":[{"code":"2950177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.0,"setting":"both","billing_class":"facility"}]},{"description":"SCS 1 CBLE/PT KIT ST JUDE-PCF","code_information":[{"code":"2950178","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"setting":"both","billing_class":"facility"}]},{"description":"DEST W NEROL GENICULAR NRV-PCF","code_information":[{"code":"2950182","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4834.0,"setting":"both","billing_class":"facility"}]},{"description":"CARPAL TUNNEL INJ BIL-PCF","code_information":[{"code":"2950184","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"PHONE E/M LEV 2 NEW-PCF","code_information":[{"code":"2950191","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 3 NEW-PCF","code_information":[{"code":"2950192","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 4 NEW-PCF","code_information":[{"code":"2950193","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.5,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 5 NEW-PCF","code_information":[{"code":"2950194","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 1 EST-PCF","code_information":[{"code":"2950195","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 2 EST-PCF","code_information":[{"code":"2950196","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 3 EST-PCF","code_information":[{"code":"2950197","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 4 EST-PCF","code_information":[{"code":"2950198","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"PHONE E/M LEV 5 EST-PCF","code_information":[{"code":"2950199","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"INJ AAA&STRD GNCLR NRV-PCF","code_information":[{"code":"2950203","type":"CDM"},{"code":"361","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2260.75,"setting":"both","billing_class":"facility"}]},{"description":"LOW OSM 300-399MG/ML GEN-PCF","code_information":[{"code":"2950208","type":"CDM"},{"code":"255","type":"RC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"}]},{"description":"LOW OSM 200-299MG/ML GEN-PCF","code_information":[{"code":"2950209","type":"CDM"},{"code":"255","type":"RC"}],"standard_charges":[{"gross_charge":13.5,"setting":"both","billing_class":"facility"}]},{"description":"TAP BLOCK UNIL BY INJ-PCF","code_information":[{"code":"2950221","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.25,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL LEV 2 NEW-PCF","code_information":[{"code":"2951202","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 3 NEW-PCF","code_information":[{"code":"2951203","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 4 NEW-PCF","code_information":[{"code":"2951204","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.5,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 5 NEW-PCF","code_information":[{"code":"2951205","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 1 EST-PCF","code_information":[{"code":"2951206","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 2 EST-PCF","code_information":[{"code":"2951207","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 3 EST-PCF","code_information":[{"code":"2951208","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 4 EST-PCF","code_information":[{"code":"2951209","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"VIRTUAL LEV 5 EST-PCF","code_information":[{"code":"2951210","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.25,"setting":"both","modifiers":"PN","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital"}]},{"description":"SP VIRTUAL/PHONE LEV 2 NEW-PCF","code_information":[{"code":"2951212","type":"CDM"},{"code":"990","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.81,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 3 NEW-PCF","code_information":[{"code":"2951213","type":"CDM"},{"code":"990","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.06,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 4 NEW-PCF","code_information":[{"code":"2951214","type":"CDM"},{"code":"990","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.63,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 5 NEW-PCF","code_information":[{"code":"2951215","type":"CDM"},{"code":"990","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.75,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 1 EST-PCF","code_information":[{"code":"2951216","type":"CDM"},{"code":"990","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.44,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 2 EST-PCF","code_information":[{"code":"2951217","type":"CDM"},{"code":"990","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.81,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 3 EST-PCF","code_information":[{"code":"2951218","type":"CDM"},{"code":"990","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.06,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 4 EST-PCF","code_information":[{"code":"2951219","type":"CDM"},{"code":"990","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.56,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 5 EST-PCF","code_information":[{"code":"2951220","type":"CDM"},{"code":"990","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.81,"setting":"both","billing_class":"facility"}]},{"description":"NB SACR JNT W/GUIDE-PCF","code_information":[{"code":"2951222","type":"CDM"},{"code":"361","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES PCF MAC 0-30MINS","code_information":[{"code":"2951223","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":449.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES PCF MAC ADDL 15MINS","code_information":[{"code":"2951224","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":224.75,"setting":"both","billing_class":"facility"}]},{"description":"ANES PCF MODERATE SEDATION 15M","code_information":[{"code":"2951225","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"}]},{"description":"LOCAL NURSE MONITORNG PCF","code_information":[{"code":"2951226","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":192.5,"setting":"both","billing_class":"facility"}]},{"description":"PROTHROMBIN TIME-PCF","code_information":[{"code":"2957000","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","billing_class":"facility"}]},{"description":"NB OTHER PERIPHERAL BILAT-PCF","code_information":[{"code":"2957001","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NDL INSJ W/O NJX 1OR2 MUSC-PCF","code_information":[{"code":"2957002","type":"CDM"},{"code":"361","type":"RC"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"}]},{"description":"NDL INSJ W/O NJX 3 MUSC-PCF","code_information":[{"code":"2957003","type":"CDM"},{"code":"361","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"}]},{"description":"SCS TRIAL LEAD NEVRO-PCF","code_information":[{"code":"2957004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2602.0,"setting":"both","billing_class":"facility"}]},{"description":"INJECT INTRALESIONAL =<7-PCP","code_information":[{"code":"2960010","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.5,"setting":"both","billing_class":"facility"},{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"CARPAL TUNNEL INJ-PCP","code_information":[{"code":"2960011","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON SHEATH/LIGAMENT-PCP","code_information":[{"code":"2960012","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TENDON ORIGIN/INSERT-PCP","code_information":[{"code":"2960013","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT 1/2 MUSCL-PCP","code_information":[{"code":"2960014","type":"CDM"},{"code":"361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ TRIGGER PNT 3 MUSCL-PCP","code_information":[{"code":"2960015","type":"CDM"},{"code":"361","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ SM JNT/BURSA BIL-PCP","code_information":[{"code":"2960016","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":76.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ SM JNT/BURSA-PCP","code_information":[{"code":"2960017","type":"CDM"},{"code":"361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":51.0,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ MED JNT/BURS BIL-PCP","code_information":[{"code":"2960018","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":81.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ MED JNT/BURSA-PCP","code_information":[{"code":"2960019","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":54.25,"setting":"both","billing_class":"professional"}]},{"description":"DRN/INJ LG JNT/BURSA BIL-PCP","code_information":[{"code":"2960020","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":179.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DRN/INJ LG JNT/BURSA-PCP","code_information":[{"code":"2960021","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"ASPIRATE/INJ GANGLION CYST-PCP","code_information":[{"code":"2960022","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE SHNT/RSVR FOR ASP-PCP","code_information":[{"code":"2960023","type":"CDM"},{"code":"361","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"LYSIS OF EPIDURAL ADHESION-PCP","code_information":[{"code":"2960024","type":"CDM"},{"code":"361","type":"RC"},{"code":"62264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2473.5,"setting":"both","billing_class":"facility"},{"gross_charge":445.75,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL PUNCTURE,LUMBAR-PCP","code_information":[{"code":"2960025","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1494.5,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"DRN CEREBRO SPINAL FLUID-PCP","code_information":[{"code":"2960026","type":"CDM"},{"code":"361","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL BLOOD PATCH-PCP","code_information":[{"code":"2960027","type":"CDM"},{"code":"361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":224.5,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL CORD LESION SUBR TX-PCP","code_information":[{"code":"2960028","type":"CDM"},{"code":"361","type":"RC"},{"code":"62280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.25,"setting":"both","billing_class":"facility"},{"gross_charge":311.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINAL CORD LES CER/TH TX-PCP","code_information":[{"code":"2960029","type":"CDM"},{"code":"361","type":"RC"},{"code":"62281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.25,"setting":"both","billing_class":"facility"},{"gross_charge":294.0,"setting":"both","billing_class":"professional"}]},{"description":"INJ NEUROL;EPID LUMB/CAUD-PCP","code_information":[{"code":"2960030","type":"CDM"},{"code":"361","type":"RC"},{"code":"62282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.25,"setting":"both","billing_class":"facility"},{"gross_charge":271.5,"setting":"both","billing_class":"professional"}]},{"description":"DISKECTOMY,PERCUTANEOUS-PCP","code_information":[{"code":"2960031","type":"CDM"},{"code":"361","type":"RC"},{"code":"62287","type":"HCPCS"}],"standard_charges":[{"gross_charge":11890.25,"setting":"both","billing_class":"facility"},{"gross_charge":1080.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ DISK LESION-PCP","code_information":[{"code":"2960032","type":"CDM"},{"code":"361","type":"RC"},{"code":"62292","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":1078.25,"setting":"both","billing_class":"professional"}]},{"description":"INJ SPINAL ARTERY-PCP","code_information":[{"code":"2960033","type":"CDM"},{"code":"361","type":"RC"},{"code":"62294","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.25,"setting":"both","billing_class":"facility"},{"gross_charge":1816.75,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ CRV/THO W/O I-PCP","code_information":[{"code":"2960034","type":"CDM"},{"code":"361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":187.75,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ CRV/THO W/IMA-PCP","code_information":[{"code":"2960035","type":"CDM"},{"code":"361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ LUM/SAC W/O I-PCP","code_information":[{"code":"2960036","type":"CDM"},{"code":"361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":163.25,"setting":"both","billing_class":"professional"}]},{"description":"EPI STER INJ LUMB/SAC W/I-PCP","code_information":[{"code":"2960037","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REPROGRAM-PCP","code_information":[{"code":"2960038","type":"CDM"},{"code":"361","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.75,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL/REPRO-PCP","code_information":[{"code":"2960039","type":"CDM"},{"code":"361","type":"RC"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","billing_class":"professional"}]},{"description":"SCS IMPLNT NEUROSTIMULATOR-PCP","code_information":[{"code":"2960040","type":"CDM"},{"code":"361","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":13162.5,"setting":"both","billing_class":"facility"},{"gross_charge":772.25,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE NEURO ELECTRD LEADS-PCP","code_information":[{"code":"2960041","type":"CDM"},{"code":"361","type":"RC"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":609.0,"setting":"both","billing_class":"professional"}]},{"description":"REV SPINE ELTR PERQ ARAY-PCP","code_information":[{"code":"2960042","type":"CDM"},{"code":"361","type":"RC"},{"code":"63663","type":"HCPCS"}],"standard_charges":[{"gross_charge":16452.75,"setting":"both","billing_class":"facility"},{"gross_charge":847.75,"setting":"both","billing_class":"professional"}]},{"description":"NEURORECVR STIMUL INSERT-PCP","code_information":[{"code":"2960043","type":"CDM"},{"code":"361","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":77455.5,"setting":"both","billing_class":"facility"},{"gross_charge":683.5,"setting":"both","billing_class":"professional"}]},{"description":"REV/REMOVE NEURORECVR-PCP","code_information":[{"code":"2960044","type":"CDM"},{"code":"361","type":"RC"},{"code":"63688","type":"HCPCS"}],"standard_charges":[{"gross_charge":7705.25,"setting":"both","billing_class":"facility"},{"gross_charge":703.0,"setting":"both","billing_class":"professional"}]},{"description":"NB SUPRAORBITAL AREA-PCP","code_information":[{"code":"2960045","type":"CDM"},{"code":"361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"NB OCCIPITAL BIL-PCP","code_information":[{"code":"2960047","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":180.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB OCCIPITAL LT-PCP","code_information":[{"code":"2960048","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":120.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB OCCIPITAL RT-PCP","code_information":[{"code":"2960049","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":120.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB VAGUS INJ-PCP","code_information":[{"code":"2960050","type":"CDM"},{"code":"361","type":"RC"},{"code":"64408","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":162.25,"setting":"both","billing_class":"professional"}]},{"description":"NB INTERSC/BRACH PLEX BIL-PCP","code_information":[{"code":"2960054","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":183.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB INTERSC/BRACH PLEX LT-PCP","code_information":[{"code":"2960055","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":122.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB INTERSC/BRACH PLEX RT-PCP","code_information":[{"code":"2960056","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":122.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB AXILLARY BIL-PCP","code_information":[{"code":"2960057","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":199.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB AXILLARY LT-PCP","code_information":[{"code":"2960058","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":132.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB AXILLARY RT-PCP","code_information":[{"code":"2960059","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":132.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB SUPRASCAPULAR BIL-PCP","code_information":[{"code":"2960060","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":174.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB SUPRASCAPULAR LT-PCP","code_information":[{"code":"2960061","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":116.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB SUPRASCAPULAR RT-PCP","code_information":[{"code":"2960062","type":"CDM"},{"code":"361","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":116.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB INTERCOSTAL SINGLE-PCP","code_information":[{"code":"2960063","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":126.5,"setting":"both","billing_class":"professional"}]},{"description":"NB INTERCOSTAL MULTIPLE-PCP","code_information":[{"code":"2960064","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":172.5,"setting":"both","billing_class":"professional"}]},{"description":"NB ILIOINGUIN/ILOHYPOGAST-PCP","code_information":[{"code":"2960065","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"NB PUDENDAL INJ-PCP","code_information":[{"code":"2960066","type":"CDM"},{"code":"361","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":151.0,"setting":"both","billing_class":"professional"}]},{"description":"NB SCIATIC BIL-PCP","code_information":[{"code":"2960067","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":156.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB SCIATIC LT-PCP","code_information":[{"code":"2960068","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":104.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB SCIATIC RT-PCP","code_information":[{"code":"2960069","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":104.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB FEMORAL BIL-PCP","code_information":[{"code":"2960070","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":188.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB FEMORAL LT-PCP","code_information":[{"code":"2960071","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":125.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB FEMORAL RT-PCP","code_information":[{"code":"2960072","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":125.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"NB OTHER PERIPHERAL-PCP","code_information":[{"code":"2960073","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.75,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANSF EPI INJ C/T BIL-PCP","code_information":[{"code":"2960074","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":370.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ C/T LT-PCP","code_information":[{"code":"2960075","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":247.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T RT-PCP","code_information":[{"code":"2960076","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":247.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD LT-PCP","code_information":[{"code":"2960077","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":118.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ C/T AD RT-PCP","code_information":[{"code":"2960078","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":118.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 LT-PCP","code_information":[{"code":"2960079","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":210.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 RT-PCP","code_information":[{"code":"2960080","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":210.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SACL1 BI-PCP","code_information":[{"code":"2960081","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":315.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"TRANSF EPI INJ L/SAC A RT-PCP","code_information":[{"code":"2960082","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A LT-PCP","code_information":[{"code":"2960083","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"TRANSF EPI INJ L/SAC A BI-PCP","code_information":[{"code":"2960084","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"setting":"both","billing_class":"facility"},{"gross_charge":147.0,"setting":"both","billing_class":"professional"}]},{"description":"FACET CER/THORA LEV 1 BIL-PCP","code_information":[{"code":"2960085","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":299.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA LEV 1 RT-PCP","code_information":[{"code":"2960086","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":199.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA LEV 1 LT-PCP","code_information":[{"code":"2960087","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":199.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THOR L2 ADD BIL-PCP","code_information":[{"code":"2960088","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":170.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THOR L2 ADD RT-PCP","code_information":[{"code":"2960089","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":113.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THOR L2 ADD LT-PCP","code_information":[{"code":"2960090","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":113.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THORA NB L3 BIL-PCP","code_information":[{"code":"2960091","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":171.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET CER/THORA NB L3 RT-PCP","code_information":[{"code":"2960092","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":114.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA NB L3 LT-PCP","code_information":[{"code":"2960093","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":114.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1  LT-PCP","code_information":[{"code":"2960094","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":170.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SACRAL LV1 RT-PCP","code_information":[{"code":"2960095","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":170.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SACRAL LI BIL-PCP","code_information":[{"code":"2960096","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":256.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L2 ADDL RT-PCP","code_information":[{"code":"2960097","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL LT-PCP","code_information":[{"code":"2960098","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":98.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L2 ADDL BIL-PCP","code_information":[{"code":"2960099","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":147.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"FACET LUM/SAC L3 ADDL RT-PCP","code_information":[{"code":"2960100","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":99.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL LT-PCP","code_information":[{"code":"2960101","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":99.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET LUM/SAC L3 ADDL BIL-PCP","code_information":[{"code":"2960102","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.25,"setting":"both","billing_class":"facility"},{"gross_charge":149.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SPHENOPALATINE GANGLION BL-PCP","code_information":[{"code":"2960103","type":"CDM"},{"code":"361","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"NB STELLATE GANGLION BIL-PCP","code_information":[{"code":"2960104","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":210.25,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB STELLATE GANGLION LT-PCP","code_information":[{"code":"2960105","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":139.75,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"NB STELLATE GANGLIOM RT-PCP","code_information":[{"code":"2960106","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":139.75,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HYPOGASTRIC PLEXUS BLOCK-PCP","code_information":[{"code":"2960107","type":"CDM"},{"code":"361","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"SYMPATHET BL THO/LUMB/CAUD-PCP","code_information":[{"code":"2960108","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"NB CELIAC PEL INJ-PCP","code_information":[{"code":"2960109","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"DEST W NEUROL TRIGEM NERVE-PCP","code_information":[{"code":"2960110","type":"CDM"},{"code":"361","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":424.5,"setting":"both","billing_class":"professional"}]},{"description":"CHEMODENERV MUSC MIGRAINE-PCP","code_information":[{"code":"2960111","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"setting":"both","billing_class":"facility"},{"gross_charge":235.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST W NEROL INTERCOST NRV-PCP","code_information":[{"code":"2960112","type":"CDM"},{"code":"361","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":323.5,"setting":"both","billing_class":"professional"}]},{"description":"NERVE TX INJ OF PUDENDA-PCP","code_information":[{"code":"2960113","type":"CDM"},{"code":"361","type":"RC"},{"code":"64630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":359.25,"setting":"both","billing_class":"professional"}]},{"description":"MORTON NEUROMA INJECTION-PCP","code_information":[{"code":"2960114","type":"CDM"},{"code":"361","type":"RC"},{"code":"64632","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERTEBRAL NRV CT-PCP","code_information":[{"code":"2960115","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":778.5,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT NRV CT BIL-PCP","code_information":[{"code":"2960116","type":"CDM"},{"code":"361","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":6716.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1168.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL BIL-PCP","code_information":[{"code":"2960117","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":525.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT CT ADDL-PCP","code_information":[{"code":"2960118","type":"CDM"},{"code":"361","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.5,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT NRV L/S-PCP","code_information":[{"code":"2960119","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":770.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT NRV L/S BIL-PCP","code_information":[{"code":"2960120","type":"CDM"},{"code":"361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6716.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1155.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"DEST PARAVERT N ADDL-PCP","code_information":[{"code":"2960121","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.5,"setting":"both","billing_class":"facility"},{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"DEST PARAVERT N ADDL BIL-PCP","code_information":[{"code":"2960122","type":"CDM"},{"code":"361","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":477.5,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NEUROLYSIS LUMBAR-PCP","code_information":[{"code":"2960123","type":"CDM"},{"code":"361","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":176.5,"setting":"both","billing_class":"professional"}]},{"description":"NRV TX INJ OF CELIAC PLEX-PCP","code_information":[{"code":"2960124","type":"CDM"},{"code":"361","type":"RC"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"NERVE DECOMPRESSION-PCP","code_information":[{"code":"2960125","type":"CDM"},{"code":"361","type":"RC"},{"code":"64722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":672.25,"setting":"both","billing_class":"professional"}]},{"description":"NERVOUS SYSTEM UNLIST PROC-PCP","code_information":[{"code":"2960126","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.75,"setting":"both","billing_class":"facility"},{"gross_charge":662.0,"setting":"both","billing_class":"professional"}]},{"description":"RETROBULBAR INJECTION-PCP","code_information":[{"code":"2960127","type":"CDM"},{"code":"361","type":"RC"},{"code":"67500","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.5,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","billing_class":"professional"}]},{"description":"DISCOGRAPHY CERV/THOR-PCP","code_information":[{"code":"2960128","type":"CDM"},{"code":"320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":207.25,"setting":"both","billing_class":"professional"}]},{"description":"DISCOGRAPHY LUMBAR-PCP","code_information":[{"code":"2960129","type":"CDM"},{"code":"320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.75,"setting":"both","billing_class":"facility"},{"gross_charge":179.75,"setting":"both","billing_class":"professional"}]},{"description":"US GUIDANCE INJECT PLACEM-PCP","code_information":[{"code":"2960131","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"ANALYZE NEUROSTIM NO PROGR-PCP","code_information":[{"code":"2960134","type":"CDM"},{"code":"920","type":"RC"},{"code":"95970","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.75,"setting":"both","billing_class":"facility"},{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"ANALYZE NEUROSTIM SIMPLE-PCP","code_information":[{"code":"2960135","type":"CDM"},{"code":"920","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.25,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"IMPL DRG PUMP REFILL-PCP","code_information":[{"code":"2960136","type":"CDM"},{"code":"260","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","billing_class":"professional"}]},{"description":"IV THERAPY DIAG 1ST HR-PCP","code_information":[{"code":"2960137","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.25,"setting":"both","billing_class":"facility"},{"gross_charge":134.75,"setting":"both","billing_class":"professional"}]},{"description":"INJECTION THER/PROPH/DIAG-PCP","code_information":[{"code":"2960138","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","billing_class":"facility"},{"gross_charge":24.5,"setting":"both","billing_class":"professional"}]},{"description":"DIAG INJ IV PUSH INIT-PCP","code_information":[{"code":"2960139","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.75,"setting":"both","billing_class":"facility"},{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ADMIN INTO CNS-PCP","code_information":[{"code":"2960140","type":"CDM"},{"code":"331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.75,"setting":"both","billing_class":"facility"},{"gross_charge":150.0,"setting":"both","billing_class":"professional"}]},{"description":"OMT 1-2 BODY REGIONS-PCP","code_information":[{"code":"2960141","type":"CDM"},{"code":"530","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"facility"},{"gross_charge":28.75,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 2 VISIT NEW PT-PCP","code_information":[{"code":"2960143","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"},{"gross_charge":101.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 3 VISIT NEW PT-PCP","code_information":[{"code":"2960144","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"},{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 4 VISIT NEW PT-PCP","code_information":[{"code":"2960145","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"},{"gross_charge":217.5,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 5 VISIT NEW PT-PCP","code_information":[{"code":"2960146","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"},{"gross_charge":272.5,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 1 VISIT EST PT-PCP","code_information":[{"code":"2960147","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 2 VISIT EST PT-PCP","code_information":[{"code":"2960148","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 3 VISIT EST PT-PCP","code_information":[{"code":"2960149","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"},{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 4 VISIT EST PT-PCP","code_information":[{"code":"2960150","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"},{"gross_charge":144.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 5 VISIT EST PT-PCP","code_information":[{"code":"2960151","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"},{"gross_charge":192.0,"setting":"both","billing_class":"professional"}]},{"description":"MINIMALY INV LAMIN DECOM-PCP","code_information":[{"code":"2960152","type":"CDM"},{"code":"361","type":"RC"},{"code":"0275T","type":"HCPCS"}],"standard_charges":[{"gross_charge":7253.0,"setting":"both","billing_class":"facility"},{"gross_charge":6862.75,"setting":"both","billing_class":"professional"}]},{"description":"SACROILIAC JT INJ BIL-PCP","code_information":[{"code":"2960160","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.75,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ BIL-PCP","code_information":[{"code":"2960160","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"SACROILIAC JT INJ RT-PCP","code_information":[{"code":"2960161","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ RT-PCP","code_information":[{"code":"2960161","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACROILIAC JT INJ LT-PCP","code_information":[{"code":"2960162","type":"CDM"},{"code":"361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.25,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SACROILIAC JT INJ LT-PCP","code_information":[{"code":"2960162","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CAPNOGRAPHY EQUIP-PCP","code_information":[{"code":"2960174","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":174.0,"setting":"both","billing_class":"facility"},{"gross_charge":174.5,"setting":"both","billing_class":"professional"}]},{"description":"MED CONFERENCE BY PHYSIC-PCP","code_information":[{"code":"2960177","type":"CDM"},{"code":"270","type":"RC"},{"code":"S0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.75,"setting":"both","billing_class":"facility"},{"gross_charge":26.75,"setting":"both","billing_class":"professional"}]},{"description":"DEST W NEROL GENICULAR NRV-PCP","code_information":[{"code":"2960182","type":"CDM"},{"code":"361","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2037.0,"setting":"both","billing_class":"facility"},{"gross_charge":756.0,"setting":"both","billing_class":"professional"}]},{"description":"CARPAL TUNNEL INJ BIL-PCP","code_information":[{"code":"2960184","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.75,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":124.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"REMOVE EVAL OF IMAGE-PCP","code_information":[{"code":"2960185","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2010","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"REMOVE EVAL OF IMAGE-PCP","code_information":[{"code":"2960185","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":23.5,"setting":"both","billing_class":"facility"}]},{"description":"BRIEF COMM TECH-BASED SVC-PCP","code_information":[{"code":"2960186","type":"CDM"},{"code":"510","type":"RC"},{"code":"98016","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"setting":"both","billing_class":"facility"},{"gross_charge":27.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW SF 15 MIN-PCP","code_information":[{"code":"2960187","type":"CDM"},{"code":"960","type":"RC"},{"code":"98008","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.22,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW SF 15 MIN-PCP","code_information":[{"code":"2960187","type":"CDM"},{"code":"960","type":"RC"}],"standard_charges":[{"gross_charge":45.22,"setting":"both","billing_class":"facility"}]},{"description":"AUDIO-ONLY NEW LOW 30 MIN-PCP","code_information":[{"code":"2960188","type":"CDM"},{"code":"960","type":"RC"},{"code":"98009","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW LOW 30 MIN-PCP","code_information":[{"code":"2960188","type":"CDM"},{"code":"960","type":"RC"}],"standard_charges":[{"gross_charge":82.75,"setting":"both","billing_class":"facility"}]},{"description":"AUDIO-ONLY NEW MOD 45 MIN-PCP","code_information":[{"code":"2960189","type":"CDM"},{"code":"960","type":"RC"},{"code":"98010","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW MOD 45 MIN-PCP","code_information":[{"code":"2960189","type":"CDM"},{"code":"960","type":"RC"}],"standard_charges":[{"gross_charge":129.25,"setting":"both","billing_class":"facility"}]},{"description":"PHONE NEW E/M SF 15MIN-PCP","code_information":[{"code":"2960191","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M SF 15MIN-PCP","code_information":[{"code":"2960191","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"}]},{"description":"PHONE NEW E/M LOW 30MIN-PCP","code_information":[{"code":"2960192","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M LOW 30MIN-PCP","code_information":[{"code":"2960192","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"}]},{"description":"PHONE NEW E/M MOD 45MIN-PCP","code_information":[{"code":"2960193","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.5,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M MOD 45MIN-PCP","code_information":[{"code":"2960193","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"}]},{"description":"PHONE NEW E/M HIGH 60MIN-PCP","code_information":[{"code":"2960194","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE NEW E/M HIGH 60MIN-PCP","code_information":[{"code":"2960194","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"}]},{"description":"PHONE E/M LEV 1 EST-PCP","code_information":[{"code":"2960195","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"PHONE E/M LEV 1 EST-PCP","code_information":[{"code":"2960195","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"setting":"both","billing_class":"facility"}]},{"description":"PHONE EST E/M SF 10MIN-PCP","code_information":[{"code":"2960196","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M SF 10MIN-PCP","code_information":[{"code":"2960196","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"}]},{"description":"PHONE EST E/M LOW 20MIN-PCP","code_information":[{"code":"2960197","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M LOW 20MIN-PCP","code_information":[{"code":"2960197","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"}]},{"description":"PHONE EST E/M MOD 30MIN-PCP","code_information":[{"code":"2960198","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M MOD 30MIN-PCP","code_information":[{"code":"2960198","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"}]},{"description":"PHONE EST E/M HIGH 40MIN-PCP","code_information":[{"code":"2960199","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","modifiers":"93","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 93: Modifier description not available"}]},{"description":"PHONE EST E/M HIGH 40MIN-PCP","code_information":[{"code":"2960199","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ AAA&STRD GNCLR NRV-PCP","code_information":[{"code":"2960203","type":"CDM"},{"code":"361","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.5,"setting":"both","billing_class":"facility"},{"gross_charge":154.25,"setting":"both","billing_class":"professional"}]},{"description":"SMOKE/TOB COUNSEL 3-10M-PCP","code_information":[{"code":"2960205","type":"CDM"},{"code":"270","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"setting":"both","billing_class":"facility"},{"gross_charge":17.5,"setting":"both","billing_class":"professional"}]},{"description":"TAP BLOCK UNIL BY INJ-PCP","code_information":[{"code":"2960221","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":107.25,"setting":"both","billing_class":"professional"}]},{"description":"VIRTUAL NEW E/M SF 15MIN-PCP","code_information":[{"code":"2961202","type":"CDM"},{"code":"511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M SF 15MIN-PCP","code_information":[{"code":"2961202","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL NEW E/M LOW 30MIN-PCP","code_information":[{"code":"2961203","type":"CDM"},{"code":"511","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M LOW 30MIN-PCP","code_information":[{"code":"2961203","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL NEW E/M MOD 45MIN-PCP","code_information":[{"code":"2961204","type":"CDM"},{"code":"511","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M MOD 45MIN-PCP","code_information":[{"code":"2961204","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL NEW E/M HIGH 60MIN-PCP","code_information":[{"code":"2961205","type":"CDM"},{"code":"511","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.5,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL NEW E/M HIGH 60MIN-PCP","code_information":[{"code":"2961205","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL LEV 1 EST-PCP","code_information":[{"code":"2961206","type":"CDM"},{"code":"511","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL LEV 1 EST-PCP","code_information":[{"code":"2961206","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL EST E/M SF 10MIN-PCP","code_information":[{"code":"2961207","type":"CDM"},{"code":"511","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.25,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M SF 10MIN-PCP","code_information":[{"code":"2961207","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":244.5,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL EST E/M LOW 20MIN-PCP","code_information":[{"code":"2961208","type":"CDM"},{"code":"511","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M LOW 20MIN-PCP","code_information":[{"code":"2961208","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL EST E/M MOD 30MIN-PCP","code_information":[{"code":"2961209","type":"CDM"},{"code":"511","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M MOD 30MIN-PCP","code_information":[{"code":"2961209","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":265.75,"setting":"both","billing_class":"facility"}]},{"description":"VIRTUAL EST E/M HIGH 40MIN-PCP","code_information":[{"code":"2961210","type":"CDM"},{"code":"511","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","modifiers":"95","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System"}]},{"description":"VIRTUAL EST E/M HIGH 40MIN-PCP","code_information":[{"code":"2961210","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":295.75,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 2 NEW-PCP","code_information":[{"code":"2961212","type":"CDM"},{"code":"990","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.25,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 2 NEW-PCP","code_information":[{"code":"2961212","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":305.63,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 3 NEW-PCP","code_information":[{"code":"2961213","type":"CDM"},{"code":"990","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.75,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 3 NEW-PCP","code_information":[{"code":"2961213","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":318.44,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 4 NEW-PCP","code_information":[{"code":"2961214","type":"CDM"},{"code":"990","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.88,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 4 NEW-PCP","code_information":[{"code":"2961214","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":332.19,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 5 NEW-PCP","code_information":[{"code":"2961215","type":"CDM"},{"code":"990","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.63,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 5 NEW-PCP","code_information":[{"code":"2961215","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":369.69,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 1 EST-PCP","code_information":[{"code":"2961216","type":"CDM"},{"code":"990","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.44,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 1 EST-PCP","code_information":[{"code":"2961216","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":290.0,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 2 EST-PCP","code_information":[{"code":"2961217","type":"CDM"},{"code":"990","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.31,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 2 EST-PCP","code_information":[{"code":"2961217","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":305.63,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 3 EST-PCP","code_information":[{"code":"2961218","type":"CDM"},{"code":"990","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 3 EST-PCP","code_information":[{"code":"2961218","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":318.44,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 4 EST-PCP","code_information":[{"code":"2961219","type":"CDM"},{"code":"990","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 4 EST-PCP","code_information":[{"code":"2961219","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":332.19,"setting":"both","billing_class":"facility"}]},{"description":"SP VIRTUAL/PHONE LEV 5 EST-PCP","code_information":[{"code":"2961220","type":"CDM"},{"code":"990","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"setting":"both","modifiers":"GT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"SP VIRTUAL/PHONE LEV 5 EST-PCP","code_information":[{"code":"2961220","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":240.0,"setting":"both","billing_class":"facility"}]},{"description":"NB SACR JNT W/GUIDE-PCP","code_information":[{"code":"2961222","type":"CDM"},{"code":"361","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.75,"setting":"both","billing_class":"facility"},{"gross_charge":391.75,"setting":"both","billing_class":"professional"}]},{"description":"BR EMOTIONAL/BEH ASSM-PCP","code_information":[{"code":"2961233","type":"CDM"},{"code":"519","type":"RC"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY NEW HIGH 60 MIN-PCP","code_information":[{"code":"2961234","type":"CDM"},{"code":"960","type":"RC"},{"code":"98011","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"setting":"both","billing_class":"facility"},{"gross_charge":168.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST SF 10 MIN-PCP","code_information":[{"code":"2961235","type":"CDM"},{"code":"960","type":"RC"},{"code":"98012","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.25,"setting":"both","billing_class":"facility"},{"gross_charge":37.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST LOW 20 MIN-PCP","code_information":[{"code":"2961236","type":"CDM"},{"code":"960","type":"RC"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"setting":"both","billing_class":"facility"},{"gross_charge":65.0,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST MOD 30 MIN-PCP","code_information":[{"code":"2961237","type":"CDM"},{"code":"960","type":"RC"},{"code":"98014","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.25,"setting":"both","billing_class":"facility"},{"gross_charge":95.25,"setting":"both","billing_class":"professional"}]},{"description":"AUDIO-ONLY EST HIGH 40 MIN-PCP","code_information":[{"code":"2961238","type":"CDM"},{"code":"960","type":"RC"},{"code":"98015","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"setting":"both","billing_class":"facility"},{"gross_charge":138.5,"setting":"both","billing_class":"professional"}]},{"description":"NB OTHER PERIPHERAL BILAT-PCP","code_information":[{"code":"2967001","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":98.0,"setting":"both","modifiers":"50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NDL INSJ W/O NJX 1OR2 MUSC-PCP","code_information":[{"code":"2967002","type":"CDM"},{"code":"361","type":"RC"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"facility"},{"gross_charge":49.75,"setting":"both","billing_class":"professional"}]},{"description":"NDL INSJ W/O NJX 3 MUSC-PCP","code_information":[{"code":"2967003","type":"CDM"},{"code":"361","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAWING FEE-ONCF","code_information":[{"code":"2980116","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"facility"}]},{"description":"AUTOPSY (NECROPSY)","code_information":[{"code":"3000001","type":"CDM"},{"code":"988","type":"RC"},{"code":"88025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1465.75,"setting":"both","billing_class":"facility"},{"gross_charge":1291.25,"setting":"both","billing_class":"professional"}]},{"description":"5-HIAA","code_information":[{"code":"3000102","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.0,"setting":"both","billing_class":"professional"}]},{"description":"NUCLEOTIDASE ASSAY","code_information":[{"code":"3000121","type":"CDM"},{"code":"300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.5,"setting":"both","billing_class":"facility"},{"gross_charge":38.0,"setting":"both","billing_class":"professional"}]},{"description":"11-DEOXYCORTISOL","code_information":[{"code":"3000136","type":"CDM"},{"code":"300","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"17-OHCS","code_information":[{"code":"3000140","type":"CDM"},{"code":"300","type":"RC"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.5,"setting":"both","billing_class":"facility"},{"gross_charge":54.0,"setting":"both","billing_class":"professional"}]},{"description":"HYDROXYPROGESTERONE 17-D","code_information":[{"code":"3000163","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.75,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"17-OH-PREGNENOLONE","code_information":[{"code":"3000164","type":"CDM"},{"code":"300","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.75,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"VEDOLIZUMAB DRUG ASSAY","code_information":[{"code":"3000165","type":"CDM"},{"code":"301","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.5,"setting":"both","billing_class":"facility"}]},{"description":"VEDOLIZUMAB DRUG ASSAY","code_information":[{"code":"3000165","type":"CDM"},{"code":"301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.75,"setting":"both","billing_class":"professional"}]},{"description":"ANTI-VEDOLIZUMAB ASSAY","code_information":[{"code":"3000166","type":"CDM"},{"code":"301","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.75,"setting":"both","billing_class":"facility"}]},{"description":"ANTI-VEDOLIZUMAB ASSAY","code_information":[{"code":"3000166","type":"CDM"},{"code":"301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"setting":"both","billing_class":"professional"}]},{"description":"ABO","code_information":[{"code":"3000191","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"setting":"both","billing_class":"facility"},{"gross_charge":141.75,"setting":"both","billing_class":"professional"}]},{"description":"PLATELET AB ID X 3","code_information":[{"code":"3000193","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.5,"setting":"both","billing_class":"facility"},{"gross_charge":233.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TST PRSMV CHEM ANLYZR","code_information":[{"code":"3000200","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":175.0,"setting":"both","billing_class":"professional"}]},{"description":"SIROLIMUS,WHOLE","code_information":[{"code":"3000205","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.5,"setting":"both","billing_class":"facility"},{"gross_charge":34.5,"setting":"both","billing_class":"professional"}]},{"description":"RIA NONANTIBODY","code_information":[{"code":"3000225","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.5,"setting":"both","billing_class":"facility"},{"gross_charge":69.0,"setting":"both","billing_class":"professional"}]},{"description":"RIA NONANTIBODY X 5","code_information":[{"code":"3000226","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.75,"setting":"both","billing_class":"facility"},{"gross_charge":341.5,"setting":"both","billing_class":"professional"}]},{"description":"RIA NONANTIBODY X 3","code_information":[{"code":"3000227","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.25,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCHOLINESTERASE  RBC","code_information":[{"code":"3000244","type":"CDM"},{"code":"301","type":"RC"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"facility"},{"gross_charge":30.25,"setting":"both","billing_class":"professional"}]},{"description":"SMEAR FLUORESCENT OR AFB STAIN","code_information":[{"code":"3000245","type":"CDM"},{"code":"306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"facility"},{"gross_charge":25.25,"setting":"both","billing_class":"professional"}]},{"description":"ACYLCARNITINE PROFILE","code_information":[{"code":"3000263","type":"CDM"},{"code":"300","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.75,"setting":"both","billing_class":"facility"},{"gross_charge":238.25,"setting":"both","billing_class":"professional"}]},{"description":"ACTH STIMULATION PANEL","code_information":[{"code":"3000264","type":"CDM"},{"code":"301","type":"RC"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.25,"setting":"both","billing_class":"facility"}]},{"description":"ADENOVIRUS ANTIBODIES","code_information":[{"code":"3000265","type":"CDM"},{"code":"300","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.0,"setting":"both","billing_class":"professional"}]},{"description":"CODEINE AND METABOLITE, BLOOD","code_information":[{"code":"3000266","type":"CDM"},{"code":"301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.5,"setting":"both","billing_class":"facility"},{"gross_charge":74.0,"setting":"both","billing_class":"professional"}]},{"description":"CLOTTING FUNCT ACTIVITY","code_information":[{"code":"3000279","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"facility"},{"gross_charge":85.25,"setting":"both","billing_class":"professional"}]},{"description":"ADRENOCORTICOTROPIC HORMONE","code_information":[{"code":"3000281","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"ACTH SERIES X8","code_information":[{"code":"3000282","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.75,"setting":"both","billing_class":"facility"},{"gross_charge":1544.5,"setting":"both","billing_class":"professional"}]},{"description":"ALPHA FETOPROTEIN SERUM","code_information":[{"code":"3000286","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"setting":"both","billing_class":"facility"},{"gross_charge":174.25,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB  TITER X 9","code_information":[{"code":"3000296","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.5,"setting":"both","billing_class":"facility"},{"gross_charge":549.25,"setting":"both","billing_class":"professional"}]},{"description":"AMINOLEVULINIC ACID","code_information":[{"code":"3000298","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.75,"setting":"both","billing_class":"facility"},{"gross_charge":108.75,"setting":"both","billing_class":"professional"}]},{"description":"ALBUMIN","code_information":[{"code":"3000300","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.5,"setting":"both","billing_class":"facility"},{"gross_charge":61.5,"setting":"both","billing_class":"professional"}]},{"description":"ONCOPROTEIN DCP","code_information":[{"code":"3000301","type":"CDM"},{"code":"300","type":"RC"},{"code":"83951","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"setting":"both","billing_class":"facility"},{"gross_charge":173.5,"setting":"both","billing_class":"professional"}]},{"description":"TRIKAFTA LEVEL (QUANT ASSAY)","code_information":[{"code":"3000302","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.25,"setting":"both","billing_class":"facility"},{"gross_charge":1409.75,"setting":"both","billing_class":"professional"}]},{"description":"SARS-COV-2 & FLU A/B AMP PRB","code_information":[{"code":"3000303","type":"CDM"},{"code":"300","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.75,"setting":"both","billing_class":"facility"},{"gross_charge":337.75,"setting":"both","billing_class":"professional"}]},{"description":"ASPERGILLUS AB X 3","code_information":[{"code":"3000304","type":"CDM"},{"code":"300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.25,"setting":"both","billing_class":"facility"},{"gross_charge":253.75,"setting":"both","billing_class":"professional"}]},{"description":"BACTERIUM AB X 7","code_information":[{"code":"3000305","type":"CDM"},{"code":"302","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.5,"setting":"both","billing_class":"facility"},{"gross_charge":406.5,"setting":"both","billing_class":"professional"}]},{"description":"ENA ANY METHOD X 9","code_information":[{"code":"3000306","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.25,"setting":"both","billing_class":"facility"},{"gross_charge":382.0,"setting":"both","billing_class":"professional"}]},{"description":"ISLET CELL AB X3","code_information":[{"code":"3000307","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.75,"setting":"both","billing_class":"facility"},{"gross_charge":447.75,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA A/B EACH AG IA","code_information":[{"code":"3000308","type":"CDM"},{"code":"306","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.75,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"ALBUMIN QUANTITATIVE","code_information":[{"code":"3000311","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"KIT (D816V) DIGITAL PCR","code_information":[{"code":"3000312","type":"CDM"},{"code":"300","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.75,"setting":"both","billing_class":"facility"}]},{"description":"COMPREHENSIVE EPILEPSY PANEL","code_information":[{"code":"3000313","type":"CDM"},{"code":"300","type":"RC"},{"code":"81419","type":"HCPCS"}],"standard_charges":[{"gross_charge":6263.25,"setting":"both","billing_class":"facility"}]},{"description":"RHEUMATOID FACTOR X3","code_information":[{"code":"3000314","type":"CDM"},{"code":"302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.25,"setting":"both","billing_class":"facility"}]},{"description":"ANTI-PHOSPHOLIPID ANTIBODY x2","code_information":[{"code":"3000315","type":"CDM"},{"code":"302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"facility"}]},{"description":"GLYCA NUC MR SPECTRSC QUAN","code_information":[{"code":"3000316","type":"CDM"},{"code":"300","type":"RC"},{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIS DELTA AGENT ANTBDY","code_information":[{"code":"3000317","type":"CDM"},{"code":"300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"facility"}]},{"description":"HLA-B","code_information":[{"code":"3000318","type":"CDM"},{"code":"300","type":"RC"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.5,"setting":"both","billing_class":"facility"}]},{"description":"BETAAMYLOID RATIO 42/40,CSF-SO","code_information":[{"code":"3000319","type":"CDM"},{"code":"300","type":"RC"},{"code":"0358U","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.25,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOHEMOGLOBIN A1C - SENDOUT","code_information":[{"code":"3000320","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.25,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":30.75,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"IMMUNOASSAY NONAB X 7","code_information":[{"code":"3000321","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"IGH VARI MUTATION ANALYSIS","code_information":[{"code":"3000322","type":"CDM"},{"code":"300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.75,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYCHLOROQUINE - SENDOUT","code_information":[{"code":"3000323","type":"CDM"},{"code":"300","type":"RC"},{"code":"80220","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.25,"setting":"both","billing_class":"facility"},{"gross_charge":263.75,"setting":"both","billing_class":"professional"}]},{"description":"VOLTAGE-GTD CA CHNL ANTB EA","code_information":[{"code":"3000324","type":"CDM"},{"code":"300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.5,"setting":"both","billing_class":"facility"}]},{"description":"FLUORESCENT AB X 25","code_information":[{"code":"3000325","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2159.25,"setting":"both","billing_class":"facility"},{"gross_charge":2097.5,"setting":"both","billing_class":"professional"}]},{"description":"LYMPH CHORIOMENINGITIS AB SO","code_information":[{"code":"3000326","type":"CDM"},{"code":"300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.0,"setting":"both","billing_class":"professional"}]},{"description":"CELL FUNCT ASSAY W/STIM X2 SO","code_information":[{"code":"3000327","type":"CDM"},{"code":"300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.5,"setting":"both","billing_class":"facility"},{"gross_charge":752.25,"setting":"both","billing_class":"professional"}]},{"description":"MICROALBUMIN QUANTITATIVE","code_information":[{"code":"3000356","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"ALDOLASE","code_information":[{"code":"3000421","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.25,"setting":"both","billing_class":"facility"},{"gross_charge":241.25,"setting":"both","billing_class":"professional"}]},{"description":"HIV-1 AG HIV-2 AB","code_information":[{"code":"3000433","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"ALDOSTERONE","code_information":[{"code":"3000442","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.25,"setting":"both","billing_class":"facility"},{"gross_charge":430.75,"setting":"both","billing_class":"professional"}]},{"description":"ALKALINE PHOSPHATASE","code_information":[{"code":"3000480","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"ALKALINE PHOSPHATASE ISOENZ","code_information":[{"code":"3000494","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.75,"setting":"both","billing_class":"facility"},{"gross_charge":58.5,"setting":"both","billing_class":"professional"}]},{"description":"ALPHA-1-ANTITRYPSIN","code_information":[{"code":"3000523","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.5,"setting":"both","billing_class":"facility"},{"gross_charge":202.0,"setting":"both","billing_class":"professional"}]},{"description":"SERPINA1 GENE","code_information":[{"code":"3000535","type":"CDM"},{"code":"310","type":"RC"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"setting":"both","billing_class":"facility"},{"gross_charge":166.5,"setting":"both","billing_class":"professional"}]},{"description":"PHENOTYPE","code_information":[{"code":"3000539","type":"CDM"},{"code":"300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.75,"setting":"both","billing_class":"facility"},{"gross_charge":162.5,"setting":"both","billing_class":"professional"}]},{"description":"CORTISOL BINDING  TRANSCORTIN","code_information":[{"code":"3000552","type":"CDM"},{"code":"300","type":"RC"},{"code":"84449","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.5,"setting":"both","billing_class":"facility"},{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"ALUMINUM ASSAY","code_information":[{"code":"3000580","type":"CDM"},{"code":"300","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"AMIKACIN","code_information":[{"code":"3000600","type":"CDM"},{"code":"301","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.75,"setting":"both","billing_class":"facility"},{"gross_charge":181.0,"setting":"both","billing_class":"professional"}]},{"description":"AMINO ACID 6/> QUAN EA","code_information":[{"code":"3000629","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"setting":"both","billing_class":"facility"},{"gross_charge":315.25,"setting":"both","billing_class":"professional"}]},{"description":"AMMONIA","code_information":[{"code":"3000661","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.25,"setting":"both","billing_class":"facility"},{"gross_charge":176.0,"setting":"both","billing_class":"professional"}]},{"description":"AMYLASE SERUM","code_information":[{"code":"3000700","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"AMYLASE X2","code_information":[{"code":"3000701","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"setting":"both","billing_class":"facility"},{"gross_charge":227.0,"setting":"both","billing_class":"professional"}]},{"description":"ANA TITER","code_information":[{"code":"3000870","type":"CDM"},{"code":"302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.25,"setting":"both","billing_class":"professional"}]},{"description":"ANDROSTENEDIONE","code_information":[{"code":"3000882","type":"CDM"},{"code":"300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.75,"setting":"both","billing_class":"facility"},{"gross_charge":112.25,"setting":"both","billing_class":"professional"}]},{"description":"ANGIOTENSIN CONVERTING ENZYME","code_information":[{"code":"3000901","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"ANTI-DNA DS","code_information":[{"code":"3000921","type":"CDM"},{"code":"302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"setting":"both","billing_class":"facility"},{"gross_charge":124.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTI DNA AB  SINGLE STRAND","code_information":[{"code":"3000960","type":"CDM"},{"code":"302","type":"RC"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"setting":"both","billing_class":"facility"},{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"CARBOHYDRATE DEFICIENT TRANS","code_information":[{"code":"3001008","type":"CDM"},{"code":"301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"ANTI HIV  EMPLOYEE","code_information":[{"code":"3001021","type":"CDM"},{"code":"300","type":"RC"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"setting":"both","billing_class":"facility"},{"gross_charge":67.75,"setting":"both","billing_class":"professional"}]},{"description":"LEUKOCYTE AB","code_information":[{"code":"3001052","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"setting":"both","billing_class":"facility"},{"gross_charge":109.0,"setting":"both","billing_class":"professional"}]},{"description":"ENA ANY METHOD X 2","code_information":[{"code":"3001064","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.75,"setting":"both","billing_class":"facility"},{"gross_charge":141.75,"setting":"both","billing_class":"professional"}]},{"description":"ABL1 GENE","code_information":[{"code":"3001066","type":"CDM"},{"code":"310","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.75,"setting":"both","billing_class":"facility"},{"gross_charge":503.75,"setting":"both","billing_class":"professional"}]},{"description":"APC GENE FULL SEQUENCE","code_information":[{"code":"3001067","type":"CDM"},{"code":"310","type":"RC"},{"code":"81201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.25,"setting":"both","billing_class":"facility"},{"gross_charge":1035.5,"setting":"both","billing_class":"professional"}]},{"description":"CEBPA A GENE FULL SEQUENCE","code_information":[{"code":"3001068","type":"CDM"},{"code":"310","type":"RC"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.75,"setting":"both","billing_class":"facility"},{"gross_charge":503.75,"setting":"both","billing_class":"professional"}]},{"description":"FANCC GENE","code_information":[{"code":"3001069","type":"CDM"},{"code":"310","type":"RC"},{"code":"81242","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"MLH1 GENE FULL SEQUENCE","code_information":[{"code":"3001070","type":"CDM"},{"code":"310","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"setting":"both","billing_class":"facility"},{"gross_charge":1024.75,"setting":"both","billing_class":"professional"}]},{"description":"MLH1 GENE DUP/DELETE VARIANT","code_information":[{"code":"3001071","type":"CDM"},{"code":"310","type":"RC"},{"code":"81294","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"setting":"both","billing_class":"facility"},{"gross_charge":306.0,"setting":"both","billing_class":"professional"}]},{"description":"MSH2 GENE FULL SEQUENCE","code_information":[{"code":"3001072","type":"CDM"},{"code":"310","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.25,"setting":"both","billing_class":"facility"},{"gross_charge":579.75,"setting":"both","billing_class":"professional"}]},{"description":"MSH2 GENE DUP/DELETE VARIANT","code_information":[{"code":"3001073","type":"CDM"},{"code":"310","type":"RC"},{"code":"81297","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"setting":"both","billing_class":"facility"},{"gross_charge":324.0,"setting":"both","billing_class":"professional"}]},{"description":"MSH6 GENE FULL SEQUENCE","code_information":[{"code":"3001074","type":"CDM"},{"code":"310","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.25,"setting":"both","billing_class":"facility"},{"gross_charge":973.75,"setting":"both","billing_class":"professional"}]},{"description":"MSH6 GENE DUP/DELETE VARIANT","code_information":[{"code":"3001075","type":"CDM"},{"code":"310","type":"RC"},{"code":"81300","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.75,"setting":"both","billing_class":"facility"},{"gross_charge":361.75,"setting":"both","billing_class":"professional"}]},{"description":"NRAS GENE VARIANT EXON 2&3","code_information":[{"code":"3001076","type":"CDM"},{"code":"310","type":"RC"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.75,"setting":"both","billing_class":"facility"},{"gross_charge":452.5,"setting":"both","billing_class":"professional"}]},{"description":"PDGFRA GENE","code_information":[{"code":"3001077","type":"CDM"},{"code":"310","type":"RC"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.75,"setting":"both","billing_class":"facility"},{"gross_charge":503.75,"setting":"both","billing_class":"professional"}]},{"description":"PML/RARALPHA COM BREAKPOINTS","code_information":[{"code":"3001078","type":"CDM"},{"code":"310","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.5,"setting":"both","billing_class":"facility"},{"gross_charge":432.0,"setting":"both","billing_class":"professional"}]},{"description":"PTEN GENE FULL SEQUENCE","code_information":[{"code":"3001083","type":"CDM"},{"code":"310","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.5,"setting":"both","billing_class":"facility"},{"gross_charge":916.5,"setting":"both","billing_class":"professional"}]},{"description":"PTEN GENE DUP/DELETE VARIANT","code_information":[{"code":"3001084","type":"CDM"},{"code":"310","type":"RC"},{"code":"81323","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"setting":"both","billing_class":"facility"},{"gross_charge":455.25,"setting":"both","billing_class":"professional"}]},{"description":"MOPATH PROCEDURE LEVEL 4","code_information":[{"code":"3001089","type":"CDM"},{"code":"310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"facility"},{"gross_charge":281.5,"setting":"both","billing_class":"professional"}]},{"description":"MOPATH PROCEDURE LEVEL 8","code_information":[{"code":"3001090","type":"CDM"},{"code":"310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1457.5,"setting":"both","billing_class":"facility"},{"gross_charge":1284.0,"setting":"both","billing_class":"professional"}]},{"description":"SO/HL 51/>GSAP DNA/DNA&RNA","code_information":[{"code":"3001091","type":"CDM"},{"code":"310","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":5025.25,"setting":"both","billing_class":"facility"},{"gross_charge":4427.5,"setting":"both","billing_class":"professional"}]},{"description":"KIT GENE TARGETED SEQUENCE","code_information":[{"code":"3001092","type":"CDM"},{"code":"310","type":"RC"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.75,"setting":"both","billing_class":"facility"},{"gross_charge":503.75,"setting":"both","billing_class":"professional"}]},{"description":"M/PHMTRC ANALYSIS COMP ASSIST","code_information":[{"code":"3001093","type":"CDM"},{"code":"310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTITHROMBIN III ANTIGEN","code_information":[{"code":"3001099","type":"CDM"},{"code":"300","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"setting":"both","billing_class":"facility"},{"gross_charge":321.5,"setting":"both","billing_class":"professional"}]},{"description":"ANTIBODY ELUTION RBC","code_information":[{"code":"3001105","type":"CDM"},{"code":"300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTIBODY SCREEN","code_information":[{"code":"3001110","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.75,"setting":"both","billing_class":"facility"},{"gross_charge":206.75,"setting":"both","billing_class":"professional"}]},{"description":"ANITBODY TITER","code_information":[{"code":"3001112","type":"CDM"},{"code":"300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.75,"setting":"both","billing_class":"facility"},{"gross_charge":171.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTIGEN TYPING","code_information":[{"code":"3001116","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"setting":"both","billing_class":"facility"},{"gross_charge":292.0,"setting":"both","billing_class":"professional"}]},{"description":"ACTIVATED PROTEIN C RESIS","code_information":[{"code":"3001125","type":"CDM"},{"code":"300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.5,"setting":"both","billing_class":"facility"},{"gross_charge":182.75,"setting":"both","billing_class":"professional"}]},{"description":"ARSENIC","code_information":[{"code":"3001126","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.5,"setting":"both","billing_class":"facility"},{"gross_charge":116.75,"setting":"both","billing_class":"professional"}]},{"description":"PRETREAT SERUM;ARC ABSORPTION","code_information":[{"code":"3001138","type":"CDM"},{"code":"300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.5,"setting":"both","billing_class":"facility"},{"gross_charge":107.0,"setting":"both","billing_class":"professional"}]},{"description":"ARC ANTIGEN TYPING","code_information":[{"code":"3001139","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"setting":"both","billing_class":"facility"},{"gross_charge":141.75,"setting":"both","billing_class":"professional"}]},{"description":"ASCORBIC ACID (VITAMIN C)","code_information":[{"code":"3001142","type":"CDM"},{"code":"300","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility"},{"gross_charge":129.25,"setting":"both","billing_class":"professional"}]},{"description":"ASPERGILLUS AB","code_information":[{"code":"3001150","type":"CDM"},{"code":"300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.75,"setting":"both","billing_class":"facility"},{"gross_charge":85.0,"setting":"both","billing_class":"professional"}]},{"description":"APOLIPOPROTEIN EA","code_information":[{"code":"3001151","type":"CDM"},{"code":"300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.25,"setting":"both","billing_class":"professional"}]},{"description":"ASPERGILLUS ANTIGEN","code_information":[{"code":"3001158","type":"CDM"},{"code":"306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTITHROMBIN III ACTIVITY","code_information":[{"code":"3001159","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTIDIURETIC HORMONE","code_information":[{"code":"3001161","type":"CDM"},{"code":"301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"},{"gross_charge":225.0,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL THROMBO TIME PLASMA","code_information":[{"code":"3001167","type":"CDM"},{"code":"300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.75,"setting":"both","billing_class":"facility"},{"gross_charge":36.5,"setting":"both","billing_class":"professional"}]},{"description":"ANTISTREPTOLYSIN O","code_information":[{"code":"3001168","type":"CDM"},{"code":"300","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"setting":"both","billing_class":"facility"},{"gross_charge":94.0,"setting":"both","billing_class":"professional"}]},{"description":"APOLIPOPROTEIN X 2","code_information":[{"code":"3001172","type":"CDM"},{"code":"300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.5,"setting":"both","billing_class":"facility"},{"gross_charge":237.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTINUCLEAR AB","code_information":[{"code":"3001180","type":"CDM"},{"code":"302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.75,"setting":"both","billing_class":"facility"},{"gross_charge":192.75,"setting":"both","billing_class":"professional"}]},{"description":"MOPATH PROCEDURE LEVEL 1","code_information":[{"code":"3001181","type":"CDM"},{"code":"310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.25,"setting":"both","billing_class":"facility"}]},{"description":"NFCT AGENT DETECTION GI 3-5","code_information":[{"code":"3001182","type":"CDM"},{"code":"306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"setting":"both","billing_class":"facility"}]},{"description":"IADNA-DNA/RNA PROBE TQ 6-11","code_information":[{"code":"3001183","type":"CDM"},{"code":"310","type":"RC"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.75,"setting":"both","billing_class":"facility"}]},{"description":"IADNA-DNA/RNA PROBE TQ 12-25","code_information":[{"code":"3001184","type":"CDM"},{"code":"310","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"setting":"both","billing_class":"facility"}]},{"description":"CHLMYD PNEUM DNA AMP PROBE","code_information":[{"code":"3001185","type":"CDM"},{"code":"310","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"M.PNEUMON DNA AMP PROBE","code_information":[{"code":"3001186","type":"CDM"},{"code":"310","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"DETECT AGENT NOS DNA AMP","code_information":[{"code":"3001188","type":"CDM"},{"code":"310","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"LEGION PNEUMO DNA AMP PROB","code_information":[{"code":"3001190","type":"CDM"},{"code":"310","type":"RC"},{"code":"87541","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"MR-STAPH DNA AMP PROBE","code_information":[{"code":"3001191","type":"CDM"},{"code":"310","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"STREP A DNA AMP PROBE","code_information":[{"code":"3001192","type":"CDM"},{"code":"310","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"}]},{"description":"RESP VIRUS 6-11 TARGETS","code_information":[{"code":"3001193","type":"CDM"},{"code":"310","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"setting":"both","billing_class":"facility"}]},{"description":"RESP VIRUS 3-5 TARGETS","code_information":[{"code":"3001194","type":"CDM"},{"code":"310","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"setting":"both","billing_class":"facility"}]},{"description":"PAI-1 4G/POLYMORPHISM","code_information":[{"code":"3001196","type":"CDM"},{"code":"310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.25,"setting":"both","billing_class":"facility"}]},{"description":"BCR/ABL MAJOR BREAKPOINT","code_information":[{"code":"3001206","type":"CDM"},{"code":"310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"setting":"both","billing_class":"facility"},{"gross_charge":428.75,"setting":"both","billing_class":"professional"}]},{"description":"BCR/ABL MINOR BREAKPOINT","code_information":[{"code":"3001207","type":"CDM"},{"code":"310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"setting":"both","billing_class":"facility"},{"gross_charge":379.25,"setting":"both","billing_class":"professional"}]},{"description":"AMPLIF NA PROBE AGENT","code_information":[{"code":"3001208","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.75,"setting":"both","billing_class":"facility"},{"gross_charge":108.75,"setting":"both","billing_class":"professional"}]},{"description":"BRAF GENE","code_information":[{"code":"3001211","type":"CDM"},{"code":"310","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.25,"setting":"both","billing_class":"facility"},{"gross_charge":344.75,"setting":"both","billing_class":"professional"}]},{"description":"CELL FUNCTION ASSAY W STIM","code_information":[{"code":"3001213","type":"CDM"},{"code":"300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.25,"setting":"both","billing_class":"facility"},{"gross_charge":341.0,"setting":"both","billing_class":"professional"}]},{"description":"HEXAGNAL PHOSPH PLTLT NEUTRL","code_information":[{"code":"3001214","type":"CDM"},{"code":"300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.25,"setting":"both","billing_class":"facility"},{"gross_charge":28.25,"setting":"both","billing_class":"professional"}]},{"description":"BARTONELLA AB X 4","code_information":[{"code":"3001241","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.5,"setting":"both","billing_class":"facility"},{"gross_charge":249.75,"setting":"both","billing_class":"professional"}]},{"description":"BARTONELLA AB","code_information":[{"code":"3001242","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"facility"},{"gross_charge":62.75,"setting":"both","billing_class":"professional"}]},{"description":"PROTOZOA AB X 2","code_information":[{"code":"3001254","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"setting":"both","billing_class":"facility"},{"gross_charge":100.25,"setting":"both","billing_class":"professional"}]},{"description":"PROTOZOA AB","code_information":[{"code":"3001255","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"setting":"both","billing_class":"facility"},{"gross_charge":50.5,"setting":"both","billing_class":"professional"}]},{"description":"BETA-2-MICROGLOBULIN","code_information":[{"code":"3001282","type":"CDM"},{"code":"300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"setting":"both","billing_class":"facility"},{"gross_charge":224.5,"setting":"both","billing_class":"professional"}]},{"description":"BETA LACTAMASE TEST","code_information":[{"code":"3001288","type":"CDM"},{"code":"300","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.75,"setting":"both","billing_class":"facility"},{"gross_charge":91.5,"setting":"both","billing_class":"professional"}]},{"description":"BARTONELLA AMPLIF NAP","code_information":[{"code":"3001304","type":"CDM"},{"code":"300","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.5,"setting":"both","billing_class":"facility"},{"gross_charge":107.5,"setting":"both","billing_class":"professional"}]},{"description":"BILE ACIDS","code_information":[{"code":"3001305","type":"CDM"},{"code":"300","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.5,"setting":"both","billing_class":"facility"},{"gross_charge":138.5,"setting":"both","billing_class":"professional"}]},{"description":"BETA 2 GPI AB X 3","code_information":[{"code":"3001315","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.75,"setting":"both","billing_class":"facility"},{"gross_charge":314.25,"setting":"both","billing_class":"professional"}]},{"description":"BETA 2 GPI AB X 2","code_information":[{"code":"3001316","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.5,"setting":"both","billing_class":"facility"},{"gross_charge":209.75,"setting":"both","billing_class":"professional"}]},{"description":"BETA 2 GPI AB","code_information":[{"code":"3001317","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"facility"},{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"BETA-HYDROXYBUTYRATE","code_information":[{"code":"3001319","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"HLA I TYPING 1 LOCUS LR","code_information":[{"code":"3001373","type":"CDM"},{"code":"300","type":"RC"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.5,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"HLA II TYPING 1 LOC HR X2","code_information":[{"code":"3001382","type":"CDM"},{"code":"300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.75,"setting":"both","billing_class":"facility"},{"gross_charge":515.75,"setting":"both","billing_class":"professional"}]},{"description":"FBN1 MOPATH PROCEDURE LEVEL 9","code_information":[{"code":"3001408","type":"CDM"},{"code":"310","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":5085.25,"setting":"both","billing_class":"facility"},{"gross_charge":4480.5,"setting":"both","billing_class":"professional"}]},{"description":"BIOTINIDASE","code_information":[{"code":"3001424","type":"CDM"},{"code":"300","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.25,"setting":"both","billing_class":"facility"},{"gross_charge":83.5,"setting":"both","billing_class":"professional"}]},{"description":"BILIRUBIN TOTAL","code_information":[{"code":"3001426","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.5,"setting":"both","billing_class":"facility"},{"gross_charge":43.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOHISTOCHEMISTRY TUMOR","code_information":[{"code":"3001428","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.75,"setting":"both","billing_class":"facility"},{"gross_charge":339.75,"setting":"both","billing_class":"professional"}]},{"description":"BLASTOMYCES ABS","code_information":[{"code":"3001433","type":"CDM"},{"code":"300","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"BLEEDING TIME","code_information":[{"code":"3001440","type":"CDM"},{"code":"300","type":"RC"},{"code":"85002","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.75,"setting":"both","billing_class":"facility"},{"gross_charge":52.5,"setting":"both","billing_class":"professional"}]},{"description":"BLOOD GASES WO2 SATURATION","code_information":[{"code":"3001450","type":"CDM"},{"code":"300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.75,"setting":"both","billing_class":"facility"},{"gross_charge":275.5,"setting":"both","billing_class":"professional"}]},{"description":"BLOOD GASES W/O2 X2","code_information":[{"code":"3001465","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"facility"},{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"BLOOD GASES W/O2","code_information":[{"code":"3001466","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.75,"setting":"both","billing_class":"professional"}]},{"description":"BORDETELLA AB X 3","code_information":[{"code":"3001478","type":"CDM"},{"code":"300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"setting":"both","billing_class":"facility"},{"gross_charge":228.25,"setting":"both","billing_class":"professional"}]},{"description":"BORDETELLA AB","code_information":[{"code":"3001479","type":"CDM"},{"code":"300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":80.0,"setting":"both","billing_class":"professional"}]},{"description":"BREATH ETHANOL","code_information":[{"code":"3001495","type":"CDM"},{"code":"300","type":"RC"},{"code":"82075","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"setting":"both","billing_class":"facility"},{"gross_charge":85.0,"setting":"both","billing_class":"professional"}]},{"description":"IA QUANT  CA 15-3","code_information":[{"code":"3001503","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"setting":"both","billing_class":"facility"},{"gross_charge":108.0,"setting":"both","billing_class":"professional"}]},{"description":"OVA1 TEST-ONCO FIVE PROTEINS","code_information":[{"code":"3001504","type":"CDM"},{"code":"300","type":"RC"},{"code":"81503","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.75,"setting":"both","billing_class":"facility"},{"gross_charge":1071.0,"setting":"both","billing_class":"professional"}]},{"description":"BUN","code_information":[{"code":"3001520","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.75,"setting":"both","billing_class":"professional"}]},{"description":"B12 BINDING CAPACITY","code_information":[{"code":"3001530","type":"CDM"},{"code":"300","type":"RC"},{"code":"82608","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.75,"setting":"both","billing_class":"facility"},{"gross_charge":271.0,"setting":"both","billing_class":"professional"}]},{"description":"C-PEPTIDE","code_information":[{"code":"3001601","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.5,"setting":"both","billing_class":"facility"},{"gross_charge":409.0,"setting":"both","billing_class":"professional"}]},{"description":"C-REACTIVE PROTEIN","code_information":[{"code":"3001620","type":"CDM"},{"code":"302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.25,"setting":"both","billing_class":"facility"},{"gross_charge":14.75,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEMENT FCN ACTIVITY EA","code_information":[{"code":"3001640","type":"CDM"},{"code":"300","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.25,"setting":"both","billing_class":"facility"},{"gross_charge":146.25,"setting":"both","billing_class":"professional"}]},{"description":"CA 125","code_information":[{"code":"3001660","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.0,"setting":"both","billing_class":"professional"}]},{"description":"CA 19-9","code_information":[{"code":"3001699","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.0,"setting":"both","billing_class":"professional"}]},{"description":"CADMIUM","code_information":[{"code":"3001712","type":"CDM"},{"code":"300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.5,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR QUANT CAFFEINE","code_information":[{"code":"3001720","type":"CDM"},{"code":"300","type":"RC"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.25,"setting":"both","billing_class":"facility"},{"gross_charge":106.0,"setting":"both","billing_class":"professional"}]},{"description":"CALCITONIN","code_information":[{"code":"3001741","type":"CDM"},{"code":"301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.75,"setting":"both","billing_class":"facility"},{"gross_charge":388.75,"setting":"both","billing_class":"professional"}]},{"description":"CALCIUM  TOTAL","code_information":[{"code":"3001760","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"CALCIUM IONIZED","code_information":[{"code":"3001781","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"CALCIUM  URINE QUAN TIMED","code_information":[{"code":"3001800","type":"CDM"},{"code":"301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"AB ENCEPHALITIS CALIF X 2","code_information":[{"code":"3001803","type":"CDM"},{"code":"300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"CALCULUS QUANT","code_information":[{"code":"3001811","type":"CDM"},{"code":"300","type":"RC"},{"code":"82360","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.25,"setting":"both","billing_class":"facility"},{"gross_charge":383.5,"setting":"both","billing_class":"professional"}]},{"description":"CANDIDA ANTIBODY","code_information":[{"code":"3001815","type":"CDM"},{"code":"300","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.75,"setting":"both","billing_class":"facility"},{"gross_charge":282.25,"setting":"both","billing_class":"professional"}]},{"description":"CARBAMAZEPINE (TEGRETOL)","code_information":[{"code":"3001820","type":"CDM"},{"code":"300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.5,"setting":"both","billing_class":"facility"},{"gross_charge":338.5,"setting":"both","billing_class":"professional"}]},{"description":"CARBAMAZEPINE  FREE","code_information":[{"code":"3001827","type":"CDM"},{"code":"300","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.25,"setting":"both","billing_class":"facility"},{"gross_charge":274.0,"setting":"both","billing_class":"professional"}]},{"description":"CARBON DIOXIDE","code_information":[{"code":"3001840","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.5,"setting":"both","billing_class":"professional"}]},{"description":"CARBON MONOXIDE","code_information":[{"code":"3001862","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.75,"setting":"both","billing_class":"facility"},{"gross_charge":103.5,"setting":"both","billing_class":"professional"}]},{"description":"CARDIOLIPIN AB IG CLASS","code_information":[{"code":"3001871","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"CARNITINE","code_information":[{"code":"3001876","type":"CDM"},{"code":"300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"setting":"both","billing_class":"facility"},{"gross_charge":378.75,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN IGG","code_information":[{"code":"3001877","type":"CDM"},{"code":"300","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"facility"},{"gross_charge":25.25,"setting":"both","billing_class":"professional"}]},{"description":"CAROTENE","code_information":[{"code":"3001878","type":"CDM"},{"code":"300","type":"RC"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":159.0,"setting":"both","billing_class":"professional"}]},{"description":"CATECHOLAMINES","code_information":[{"code":"3001887","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"setting":"both","billing_class":"facility"},{"gross_charge":93.0,"setting":"both","billing_class":"professional"}]},{"description":"CEA","code_information":[{"code":"3001920","type":"CDM"},{"code":"301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.75,"setting":"both","billing_class":"facility"},{"gross_charge":263.0,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA IGM AB","code_information":[{"code":"3001996","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"facility"},{"gross_charge":62.75,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA AB X 2","code_information":[{"code":"3001997","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.5,"setting":"both","billing_class":"facility"},{"gross_charge":120.25,"setting":"both","billing_class":"professional"}]},{"description":"CELL COUNT  FLUID","code_information":[{"code":"3002019","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.25,"setting":"both","billing_class":"facility"},{"gross_charge":120.75,"setting":"both","billing_class":"professional"}]},{"description":"ANTIBODY IDENTIFICATION  WARM","code_information":[{"code":"3002036","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.25,"setting":"both","billing_class":"facility"},{"gross_charge":338.25,"setting":"both","billing_class":"professional"}]},{"description":"CERULOPLASMIN","code_information":[{"code":"3002041","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","billing_class":"facility"},{"gross_charge":168.25,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEMENT TOTAL (CH50)","code_information":[{"code":"3002051","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.25,"setting":"both","billing_class":"facility"},{"gross_charge":334.0,"setting":"both","billing_class":"professional"}]},{"description":"BASIC METABOLIC PANEL","code_information":[{"code":"3002081","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"setting":"both","billing_class":"facility"},{"gross_charge":246.5,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA IGM AB X 3","code_information":[{"code":"3002088","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.75,"setting":"both","billing_class":"facility"},{"gross_charge":187.25,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA AB X 3","code_information":[{"code":"3002089","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":179.75,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA AB X 6","code_information":[{"code":"3002096","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.25,"setting":"both","billing_class":"facility"},{"gross_charge":358.75,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA AB","code_information":[{"code":"3002097","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.5,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA P AMPLIF NA PROBE","code_information":[{"code":"3002110","type":"CDM"},{"code":"300","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.75,"setting":"both","billing_class":"facility"},{"gross_charge":107.75,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA T AMPLIF NA PROBE","code_information":[{"code":"3002121","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.25,"setting":"both","billing_class":"facility"},{"gross_charge":176.0,"setting":"both","billing_class":"professional"}]},{"description":"COLUMN CHROMATO/MASS SPECT","code_information":[{"code":"3002145","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.25,"setting":"both","billing_class":"facility"},{"gross_charge":80.25,"setting":"both","billing_class":"professional"}]},{"description":"CHLORIDE  BLOOD","code_information":[{"code":"3002180","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.75,"setting":"both","billing_class":"facility"},{"gross_charge":53.5,"setting":"both","billing_class":"professional"}]},{"description":"CHLORIDE URINE","code_information":[{"code":"3002220","type":"CDM"},{"code":"301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.5,"setting":"both","billing_class":"facility"},{"gross_charge":82.25,"setting":"both","billing_class":"professional"}]},{"description":"CHLORIDE  STOOL","code_information":[{"code":"3002221","type":"CDM"},{"code":"300","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.25,"setting":"both","billing_class":"facility"},{"gross_charge":41.5,"setting":"both","billing_class":"professional"}]},{"description":"CHOLESTEROL","code_information":[{"code":"3002280","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":97.5,"setting":"both","billing_class":"professional"}]},{"description":"IA QUAN OTH AG","code_information":[{"code":"3002383","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"setting":"both","billing_class":"facility"},{"gross_charge":161.75,"setting":"both","billing_class":"professional"}]},{"description":"CHROMIUM","code_information":[{"code":"3002390","type":"CDM"},{"code":"301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.75,"setting":"both","billing_class":"facility"},{"gross_charge":224.25,"setting":"both","billing_class":"professional"}]},{"description":"CHROM ANALY ADDL X2","code_information":[{"code":"3002401","type":"CDM"},{"code":"311","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.5,"setting":"both","billing_class":"facility"},{"gross_charge":146.5,"setting":"both","billing_class":"professional"}]},{"description":"CHROMOSONE ANALYSIS 5 CELL","code_information":[{"code":"3002403","type":"CDM"},{"code":"311","type":"RC"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.5,"setting":"both","billing_class":"facility"},{"gross_charge":496.0,"setting":"both","billing_class":"professional"}]},{"description":"CHROM ANALYSIS","code_information":[{"code":"3002404","type":"CDM"},{"code":"311","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.75,"setting":"both","billing_class":"facility"},{"gross_charge":329.0,"setting":"both","billing_class":"professional"}]},{"description":"CHROM ANALYSIS CT20-25","code_information":[{"code":"3002407","type":"CDM"},{"code":"311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"setting":"both","billing_class":"facility"},{"gross_charge":354.0,"setting":"both","billing_class":"professional"}]},{"description":"CHROMOSOME ANALYSIS","code_information":[{"code":"3002417","type":"CDM"},{"code":"311","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"facility"},{"gross_charge":73.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB X 9","code_information":[{"code":"3002419","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"setting":"both","billing_class":"facility"},{"gross_charge":765.5,"setting":"both","billing_class":"professional"}]},{"description":"FXN GENE KNOWN FAMIL VARIANT","code_information":[{"code":"3002423","type":"CDM"},{"code":"310","type":"RC"},{"code":"81289","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.5,"setting":"both","billing_class":"facility"},{"gross_charge":507.75,"setting":"both","billing_class":"professional"}]},{"description":"PMS2 GENE FULL SEQ ANALYSIS","code_information":[{"code":"3002424","type":"CDM"},{"code":"310","type":"RC"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.5,"setting":"both","billing_class":"facility"},{"gross_charge":1830.5,"setting":"both","billing_class":"professional"}]},{"description":"CITRATE","code_information":[{"code":"3002443","type":"CDM"},{"code":"300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"CKMB","code_information":[{"code":"3002449","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.75,"setting":"both","billing_class":"facility"},{"gross_charge":192.75,"setting":"both","billing_class":"professional"}]},{"description":"URINALYS WO MICRO","code_information":[{"code":"3002451","type":"CDM"},{"code":"307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.5,"setting":"both","billing_class":"facility"},{"gross_charge":45.25,"setting":"both","billing_class":"professional"}]},{"description":"CLOZAPINE","code_information":[{"code":"3002461","type":"CDM"},{"code":"300","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"CLOSTRIDIUM AG IA","code_information":[{"code":"3002464","type":"CDM"},{"code":"306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.25,"setting":"both","billing_class":"facility"},{"gross_charge":31.75,"setting":"both","billing_class":"professional"}]},{"description":"CYTOMEGALOVIRUS AB IGG","code_information":[{"code":"3002482","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTOMEGALOVIRUS AB IGM","code_information":[{"code":"3002483","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"CMV PCR","code_information":[{"code":"3002491","type":"CDM"},{"code":"300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.25,"setting":"both","billing_class":"facility"},{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"CYTOMEGALOVIRUS QUANT","code_information":[{"code":"3002492","type":"CDM"},{"code":"300","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.5,"setting":"both","billing_class":"facility"},{"gross_charge":528.0,"setting":"both","billing_class":"professional"}]},{"description":"COAGULATION FACTOR II","code_information":[{"code":"3002521","type":"CDM"},{"code":"300","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"facility"},{"gross_charge":144.5,"setting":"both","billing_class":"professional"}]},{"description":"COAGULATION FACTOR VII","code_information":[{"code":"3002581","type":"CDM"},{"code":"300","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","billing_class":"facility"},{"gross_charge":125.25,"setting":"both","billing_class":"professional"}]},{"description":"IODINE SERUM","code_information":[{"code":"3002584","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.5,"setting":"both","billing_class":"facility"},{"gross_charge":103.25,"setting":"both","billing_class":"professional"}]},{"description":"COAG FACTOR VIII ACTIVITY","code_information":[{"code":"3002601","type":"CDM"},{"code":"300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.75,"setting":"both","billing_class":"facility"},{"gross_charge":172.25,"setting":"both","billing_class":"professional"}]},{"description":"CLOTTING FACTOR X","code_information":[{"code":"3002602","type":"CDM"},{"code":"300","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":130.25,"setting":"both","billing_class":"professional"}]},{"description":"COAGULATION FACTOR XII","code_information":[{"code":"3002620","type":"CDM"},{"code":"300","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"COCCIDIOIDES AB","code_information":[{"code":"3002632","type":"CDM"},{"code":"300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.5,"setting":"both","billing_class":"facility"},{"gross_charge":59.25,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE ACCESS DEV","code_information":[{"code":"3002639","type":"CDM"},{"code":"761","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.25,"setting":"both","billing_class":"facility"}]},{"description":"COLD AGGLUTININS","code_information":[{"code":"3002640","type":"CDM"},{"code":"300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.75,"setting":"both","billing_class":"facility"},{"gross_charge":227.75,"setting":"both","billing_class":"professional"}]},{"description":"COLLAGEN CROSS LINKS","code_information":[{"code":"3002642","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"facility"},{"gross_charge":94.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAWING FEE PATERNITY TESTING","code_information":[{"code":"3002644","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"facility"}]},{"description":"DRAWING FEE PATERNITY TESTING","code_information":[{"code":"3002644","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":105.25,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEMENT  AG EA X 2","code_information":[{"code":"3002645","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.5,"setting":"both","billing_class":"facility"},{"gross_charge":375.5,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEMENT  AG EA","code_information":[{"code":"3002660","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.5,"setting":"both","billing_class":"facility"},{"gross_charge":188.0,"setting":"both","billing_class":"professional"}]},{"description":"COMPREHENSIVE METABOLIC PANEL","code_information":[{"code":"3002711","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"facility"},{"gross_charge":317.0,"setting":"both","billing_class":"professional"}]},{"description":"GENERAL HEALTH SCREEN","code_information":[{"code":"3002712","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"setting":"both","billing_class":"facility"}]},{"description":"CONSULTATION PATH SEND OUT","code_information":[{"code":"3002714","type":"CDM"},{"code":"310","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.75,"setting":"both","billing_class":"facility"},{"gross_charge":339.75,"setting":"both","billing_class":"professional"}]},{"description":"CONCENTRATION FOR INFECT AGENT","code_information":[{"code":"3002717","type":"CDM"},{"code":"306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.0,"setting":"both","billing_class":"professional"}]},{"description":"CBC WITH AUTO DIFF","code_information":[{"code":"3002720","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"facility"},{"gross_charge":116.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TEST DEF 1-7 CLASSES","code_information":[{"code":"3002733","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":175.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TEST DEF 1-7 CLASSES","code_information":[{"code":"3002733","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"setting":"both","billing_class":"facility"}]},{"description":"DRUG TEST DEF 22 CLASSES","code_information":[{"code":"3002734","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0483","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"setting":"both","billing_class":"facility"},{"gross_charge":334.25,"setting":"both","billing_class":"professional"}]},{"description":"COPPER","code_information":[{"code":"3002744","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"CORTISOL","code_information":[{"code":"3002747","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.25,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","billing_class":"professional"}]},{"description":"CORTICOSTERONE","code_information":[{"code":"3002750","type":"CDM"},{"code":"301","type":"RC"},{"code":"82528","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":114.75,"setting":"both","billing_class":"professional"}]},{"description":"CORTISOL URINARY FREE","code_information":[{"code":"3002755","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"CPK  TOTAL","code_information":[{"code":"3002783","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"facility"},{"gross_charge":96.25,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROVIRUS AB X 8","code_information":[{"code":"3002793","type":"CDM"},{"code":"300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"setting":"both","billing_class":"facility"},{"gross_charge":563.75,"setting":"both","billing_class":"professional"}]},{"description":"CORTISOL X 3","code_information":[{"code":"3002795","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.5,"setting":"both","billing_class":"facility"},{"gross_charge":247.0,"setting":"both","billing_class":"professional"}]},{"description":"CPK ISOENZYMES","code_information":[{"code":"3002799","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN WESTERN BLOT","code_information":[{"code":"3002825","type":"CDM"},{"code":"300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"setting":"both","billing_class":"facility"},{"gross_charge":57.0,"setting":"both","billing_class":"professional"}]},{"description":"CREATINE","code_information":[{"code":"3002830","type":"CDM"},{"code":"301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"CREATININE  BLOOD","code_information":[{"code":"3002840","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"},{"gross_charge":65.0,"setting":"both","billing_class":"professional"}]},{"description":"CREATININE CLEARANCE  24HR UR","code_information":[{"code":"3002860","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.25,"setting":"both","billing_class":"facility"},{"gross_charge":156.0,"setting":"both","billing_class":"professional"}]},{"description":"CREATININE","code_information":[{"code":"3002881","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.5,"setting":"both","billing_class":"facility"},{"gross_charge":24.75,"setting":"both","billing_class":"professional"}]},{"description":"COMPATIBILITY TST EA UNIT","code_information":[{"code":"3002915","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.75,"setting":"both","billing_class":"facility"},{"gross_charge":369.5,"setting":"both","billing_class":"professional"}]},{"description":"COMPATIBILITY EA UNIT ANTIGLOB","code_information":[{"code":"3002916","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.75,"setting":"both","billing_class":"facility"},{"gross_charge":369.5,"setting":"both","billing_class":"professional"}]},{"description":"CRP  ULTRA QUANT","code_information":[{"code":"3002917","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"setting":"both","billing_class":"facility"},{"gross_charge":468.5,"setting":"both","billing_class":"professional"}]},{"description":"CRYOFIBRINOGEN","code_information":[{"code":"3002919","type":"CDM"},{"code":"300","type":"RC"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.5,"setting":"both","billing_class":"professional"}]},{"description":"CRYOGLOBULIN SERUM","code_information":[{"code":"3002922","type":"CDM"},{"code":"300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.0,"setting":"both","billing_class":"professional"}]},{"description":"CRYTOCOCCUS AB","code_information":[{"code":"3002942","type":"CDM"},{"code":"300","type":"RC"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"3002946","type":"CDM"},{"code":"300","type":"RC"},{"code":"87272","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.25,"setting":"both","billing_class":"facility"},{"gross_charge":157.0,"setting":"both","billing_class":"professional"}]},{"description":"CRYSTALS  BODY FLUID","code_information":[{"code":"3002960","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","billing_class":"facility"},{"gross_charge":125.25,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE,MYRIAD","code_information":[{"code":"3003009","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":20.75,"setting":"both","billing_class":"facility"},{"gross_charge":18.25,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  ANAEROBIC","code_information":[{"code":"3003160","type":"CDM"},{"code":"306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.75,"setting":"both","billing_class":"facility"},{"gross_charge":229.5,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE EA ANTISERUM","code_information":[{"code":"3003161","type":"CDM"},{"code":"306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.25,"setting":"both","billing_class":"facility"},{"gross_charge":17.75,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  BLOOD","code_information":[{"code":"3003180","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.75,"setting":"both","billing_class":"facility"},{"gross_charge":188.25,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  BLOOD FOR FUNGUS","code_information":[{"code":"3003185","type":"CDM"},{"code":"306","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","billing_class":"facility"},{"gross_charge":35.25,"setting":"both","billing_class":"professional"}]},{"description":"CHLAMYDIA CULTURE","code_information":[{"code":"3003220","type":"CDM"},{"code":"306","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.75,"setting":"both","billing_class":"facility"},{"gross_charge":570.5,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  FUNGAL","code_information":[{"code":"3003320","type":"CDM"},{"code":"306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","billing_class":"facility"},{"gross_charge":35.25,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  SKIN/NAIL FOR FUNGUS","code_information":[{"code":"3003321","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","billing_class":"facility"},{"gross_charge":35.25,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  STOOL","code_information":[{"code":"3003509","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.5,"setting":"both","billing_class":"facility"},{"gross_charge":192.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY QUANT NONAB X 3","code_information":[{"code":"3003522","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.75,"setting":"both","billing_class":"facility"},{"gross_charge":198.75,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  URINE","code_information":[{"code":"3003540","type":"CDM"},{"code":"306","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"setting":"both","billing_class":"facility"},{"gross_charge":142.75,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  URINE WITH ID","code_information":[{"code":"3003541","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"facility"},{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  VIRAL MDPH","code_information":[{"code":"3003560","type":"CDM"},{"code":"306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"facility"},{"gross_charge":73.75,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  BACTERIAL","code_information":[{"code":"3003580","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.5,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"CYANIDE  BLOOD","code_information":[{"code":"3003590","type":"CDM"},{"code":"301","type":"RC"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.5,"setting":"both","billing_class":"facility"},{"gross_charge":44.25,"setting":"both","billing_class":"professional"}]},{"description":"CYCLOSPORINE","code_information":[{"code":"3003601","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"AMINO ACIDS  CYSTINE","code_information":[{"code":"3003605","type":"CDM"},{"code":"300","type":"RC"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.75,"setting":"both","billing_class":"facility"},{"gross_charge":85.0,"setting":"both","billing_class":"professional"}]},{"description":"HELMINTH AB","code_information":[{"code":"3003613","type":"CDM"},{"code":"300","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.25,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"CCP ANTIBODY","code_information":[{"code":"3003626","type":"CDM"},{"code":"302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"},{"gross_charge":217.75,"setting":"both","billing_class":"professional"}]},{"description":"D-DIMER","code_information":[{"code":"3003628","type":"CDM"},{"code":"305","type":"RC"},{"code":"85378","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"setting":"both","billing_class":"facility"},{"gross_charge":90.75,"setting":"both","billing_class":"professional"}]},{"description":"D-NASE B AB","code_information":[{"code":"3003629","type":"CDM"},{"code":"300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"DEHYDROEPIANDROSTERONE SUL","code_information":[{"code":"3003641","type":"CDM"},{"code":"301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.5,"setting":"both","billing_class":"facility"},{"gross_charge":331.5,"setting":"both","billing_class":"professional"}]},{"description":"DHEA","code_information":[{"code":"3003643","type":"CDM"},{"code":"300","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"facility"},{"gross_charge":127.5,"setting":"both","billing_class":"professional"}]},{"description":"N MENIGITIDIS","code_information":[{"code":"3003644","type":"CDM"},{"code":"302","type":"RC"},{"code":"86741","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"},{"gross_charge":217.75,"setting":"both","billing_class":"professional"}]},{"description":"DEXOYCORTICOSTERONE (DOC)","code_information":[{"code":"3003646","type":"CDM"},{"code":"300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"CAR ION CHNNLPATH INC 10 GNS","code_information":[{"code":"3003649","type":"CDM"},{"code":"310","type":"RC"},{"code":"81413","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.25,"setting":"both","billing_class":"facility"},{"gross_charge":1780.75,"setting":"both","billing_class":"professional"}]},{"description":"COOMBS INDIRECT QUAL","code_information":[{"code":"3003651","type":"CDM"},{"code":"302","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"},{"gross_charge":194.25,"setting":"both","billing_class":"professional"}]},{"description":"PRETREAT RBC CHEM OR DRUGS","code_information":[{"code":"3003653","type":"CDM"},{"code":"302","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":100.0,"setting":"both","billing_class":"professional"}]},{"description":"COLD AGGLUTININ SCR","code_information":[{"code":"3003658","type":"CDM"},{"code":"300","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"facility"},{"gross_charge":56.5,"setting":"both","billing_class":"professional"}]},{"description":"MONONUCLEAR CELL ANTIGEN","code_information":[{"code":"3003662","type":"CDM"},{"code":"302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.5,"setting":"both","billing_class":"professional"}]},{"description":"LP PLA2-LIPOPROTEIN","code_information":[{"code":"3003698","type":"CDM"},{"code":"300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"setting":"both","billing_class":"facility"},{"gross_charge":108.0,"setting":"both","billing_class":"professional"}]},{"description":"BL SMEAR W/DIFF WBC COUNT","code_information":[{"code":"3003720","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"setting":"both","billing_class":"facility"},{"gross_charge":67.0,"setting":"both","billing_class":"professional"}]},{"description":"EHRLICHIA AB X 2","code_information":[{"code":"3003722","type":"CDM"},{"code":"302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"facility"},{"gross_charge":101.75,"setting":"both","billing_class":"professional"}]},{"description":"DILUTE R VIPER VENON","code_information":[{"code":"3003727","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.5,"setting":"both","billing_class":"facility"},{"gross_charge":49.5,"setting":"both","billing_class":"professional"}]},{"description":"DIGOXIN","code_information":[{"code":"3003760","type":"CDM"},{"code":"301","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"setting":"both","billing_class":"facility"},{"gross_charge":168.75,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE NON-DOT SENDOUT","code_information":[{"code":"3003789","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.75,"setting":"both","billing_class":"facility"},{"gross_charge":49.75,"setting":"both","billing_class":"professional"}]},{"description":"COOMBS DIRECT","code_information":[{"code":"3003790","type":"CDM"},{"code":"302","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"setting":"both","billing_class":"facility"},{"gross_charge":232.0,"setting":"both","billing_class":"professional"}]},{"description":"DRAWING FEE ARTERIAL","code_information":[{"code":"3003834","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.5,"setting":"both","billing_class":"facility"},{"gross_charge":230.25,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE, C2N LAB","code_information":[{"code":"3003837","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.5,"setting":"both","billing_class":"facility"},{"gross_charge":28.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAWING FEE","code_information":[{"code":"3003838","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"setting":"both","billing_class":"facility"},{"gross_charge":29.75,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE DOT","code_information":[{"code":"3003847","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.75,"setting":"both","billing_class":"facility"},{"gross_charge":55.25,"setting":"both","billing_class":"professional"}]},{"description":"COLLECTION FEE, HAIR","code_information":[{"code":"3003883","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":56.75,"setting":"both","billing_class":"facility"},{"gross_charge":49.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR DOT SEND OUT","code_information":[{"code":"3003896","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":81.0,"setting":"both","billing_class":"facility"},{"gross_charge":81.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR NON DOT SEND OUT","code_information":[{"code":"3003897","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":81.0,"setting":"both","billing_class":"facility"},{"gross_charge":81.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR,URINE 7 PANEL CORP","code_information":[{"code":"3003905","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":80.25,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","billing_class":"professional"}]},{"description":"EASTERN EQUINE ENCEPHALITI AB","code_information":[{"code":"3003917","type":"CDM"},{"code":"300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"ELECTROLYTES","code_information":[{"code":"3003922","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.25,"setting":"both","billing_class":"professional"}]},{"description":"PRETREAT RBC ENZYMES","code_information":[{"code":"3003937","type":"CDM"},{"code":"300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"setting":"both","billing_class":"facility"},{"gross_charge":292.0,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROVIRUS AB","code_information":[{"code":"3003941","type":"CDM"},{"code":"300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"facility"},{"gross_charge":40.5,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROVIRUS  PCR","code_information":[{"code":"3003947","type":"CDM"},{"code":"300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB SCR","code_information":[{"code":"3003949","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":80.0,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB X 19","code_information":[{"code":"3003950","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.25,"setting":"both","billing_class":"facility"}]},{"description":"EB VCA AB X 2","code_information":[{"code":"3003951","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"facility"},{"gross_charge":155.5,"setting":"both","billing_class":"professional"}]},{"description":"EB VCA AB","code_information":[{"code":"3003952","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"EBNA","code_information":[{"code":"3003953","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"EOSINOPHILS  URINE","code_information":[{"code":"3003960","type":"CDM"},{"code":"300","type":"RC"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.75,"setting":"both","billing_class":"facility"},{"gross_charge":47.0,"setting":"both","billing_class":"professional"}]},{"description":"AB ENCEPHALITIS E EQUINE X 2","code_information":[{"code":"3003961","type":"CDM"},{"code":"300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"EBV IGG  EARLY AG","code_information":[{"code":"3003978","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"setting":"both","billing_class":"facility"},{"gross_charge":121.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCREEN-CLIENT","code_information":[{"code":"3003998","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.5,"setting":"both","billing_class":"facility"},{"gross_charge":63.5,"setting":"both","billing_class":"professional"}]},{"description":"EHRLICHIA AB X 4","code_information":[{"code":"3004003","type":"CDM"},{"code":"302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.75,"setting":"both","billing_class":"facility"},{"gross_charge":204.75,"setting":"both","billing_class":"professional"}]},{"description":"ENA ANY METHOD","code_information":[{"code":"3004007","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"HEXA GENE TAY-SACHS DNA","code_information":[{"code":"3004008","type":"CDM"},{"code":"310","type":"RC"},{"code":"81255","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.5,"setting":"both","billing_class":"facility"},{"gross_charge":198.75,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO 100-300cell X3","code_information":[{"code":"3004009","type":"CDM"},{"code":"311","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.5,"setting":"both","billing_class":"facility"},{"gross_charge":550.25,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR COURT 10","code_information":[{"code":"3004019","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"facility"},{"gross_charge":202.5,"setting":"both","billing_class":"professional"}]},{"description":"ZIKA VIRUS DNA/RNA AMP PROBE","code_information":[{"code":"3004025","type":"CDM"},{"code":"300","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.25,"setting":"both","billing_class":"facility"},{"gross_charge":186.75,"setting":"both","billing_class":"professional"}]},{"description":"ERYTHROPOIETIN","code_information":[{"code":"3004041","type":"CDM"},{"code":"301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.25,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"ESTRADIOL","code_information":[{"code":"3004059","type":"CDM"},{"code":"301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"setting":"both","billing_class":"facility"},{"gross_charge":161.75,"setting":"both","billing_class":"professional"}]},{"description":"ESTRIOL UNCONJUGATED","code_information":[{"code":"3004062","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.5,"setting":"both","billing_class":"facility"},{"gross_charge":146.5,"setting":"both","billing_class":"professional"}]},{"description":"ESTROGEN TOTAL","code_information":[{"code":"3004073","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.25,"setting":"both","billing_class":"facility"},{"gross_charge":104.0,"setting":"both","billing_class":"professional"}]},{"description":"ESTROGENS FRACTIONATED","code_information":[{"code":"3004074","type":"CDM"},{"code":"300","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.5,"setting":"both","billing_class":"facility"},{"gross_charge":80.5,"setting":"both","billing_class":"professional"}]},{"description":"ESTRONE","code_information":[{"code":"3004079","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.75,"setting":"both","billing_class":"facility"},{"gross_charge":181.0,"setting":"both","billing_class":"professional"}]},{"description":"ETHOSUXIMIDE (ZARONTIN)","code_information":[{"code":"3004080","type":"CDM"},{"code":"300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.75,"setting":"both","billing_class":"professional"}]},{"description":"ETHYLENE GLYCOL","code_information":[{"code":"3004083","type":"CDM"},{"code":"300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.5,"setting":"both","billing_class":"facility"},{"gross_charge":69.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCREEN EVEROLIMUS","code_information":[{"code":"3004084","type":"CDM"},{"code":"300","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.75,"setting":"both","billing_class":"facility"},{"gross_charge":98.0,"setting":"both","billing_class":"professional"}]},{"description":"ETEST","code_information":[{"code":"3004085","type":"CDM"},{"code":"300","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.75,"setting":"both","billing_class":"facility"},{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR V ACTIVITY","code_information":[{"code":"3004101","type":"CDM"},{"code":"300","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.5,"setting":"both","billing_class":"facility"},{"gross_charge":143.75,"setting":"both","billing_class":"professional"}]},{"description":"EXTRA PLATE (YERSINIA)","code_information":[{"code":"3004104","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"facility"},{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR IX ASSAY","code_information":[{"code":"3004109","type":"CDM"},{"code":"300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"facility"},{"gross_charge":254.25,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR INHIBITOR","code_information":[{"code":"3004121","type":"CDM"},{"code":"300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.5,"setting":"both","billing_class":"facility"},{"gross_charge":61.75,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR XI ACTIVITY ASSAY","code_information":[{"code":"3004123","type":"CDM"},{"code":"300","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"AMNIOTIC FLUID PROTEIN","code_information":[{"code":"3004124","type":"CDM"},{"code":"300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"},{"gross_charge":158.25,"setting":"both","billing_class":"professional"}]},{"description":"FECAL FAT QUALITATIVE","code_information":[{"code":"3004139","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"setting":"both","billing_class":"facility"},{"gross_charge":72.0,"setting":"both","billing_class":"professional"}]},{"description":"FECAL FAT QUANT","code_information":[{"code":"3004140","type":"CDM"},{"code":"300","type":"RC"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.5,"setting":"both","billing_class":"facility"},{"gross_charge":116.75,"setting":"both","billing_class":"professional"}]},{"description":"FATTY ACID PROFILE PEROXIS","code_information":[{"code":"3004150","type":"CDM"},{"code":"300","type":"RC"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.75,"setting":"both","billing_class":"professional"}]},{"description":"FERRITIN","code_information":[{"code":"3004180","type":"CDM"},{"code":"301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"facility"},{"gross_charge":207.75,"setting":"both","billing_class":"professional"}]},{"description":"FETAL FIBRONECTIN","code_information":[{"code":"3004199","type":"CDM"},{"code":"300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"setting":"both","billing_class":"facility"},{"gross_charge":490.5,"setting":"both","billing_class":"professional"}]},{"description":"FIBRINOGEN ANTIGEN","code_information":[{"code":"3004259","type":"CDM"},{"code":"300","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.25,"setting":"both","billing_class":"facility"},{"gross_charge":64.5,"setting":"both","billing_class":"professional"}]},{"description":"FIBRINOGEN","code_information":[{"code":"3004260","type":"CDM"},{"code":"305","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"facility"},{"gross_charge":43.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR TACROLIMUS","code_information":[{"code":"3004270","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"FLUORIDE","code_information":[{"code":"3004290","type":"CDM"},{"code":"300","type":"RC"},{"code":"82735","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"setting":"both","billing_class":"facility"}]},{"description":"FLOW CYTOMETRY FIRST MARKER","code_information":[{"code":"3004344","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"setting":"both","billing_class":"facility"},{"gross_charge":340.0,"setting":"both","billing_class":"professional"}]},{"description":"FLOW CYTOMETRY ADDL MARK X 6","code_information":[{"code":"3004351","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.75,"setting":"both","billing_class":"facility"},{"gross_charge":442.0,"setting":"both","billing_class":"professional"}]},{"description":"FLOW CYTOMETRY ADDL MARK X 8","code_information":[{"code":"3004354","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"setting":"both","billing_class":"facility"},{"gross_charge":589.25,"setting":"both","billing_class":"professional"}]},{"description":"FOLIC ACID SERUM","code_information":[{"code":"3004360","type":"CDM"},{"code":"301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"setting":"both","billing_class":"facility"},{"gross_charge":250.75,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA DNA AMP PROBE X 2","code_information":[{"code":"3004361","type":"CDM"},{"code":"306","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.5,"setting":"both","billing_class":"facility"},{"gross_charge":720.0,"setting":"both","billing_class":"professional"}]},{"description":"FOLIC ACID RBC","code_information":[{"code":"3004383","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"FRANCISELLA ABS","code_information":[{"code":"3004397","type":"CDM"},{"code":"300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"setting":"both","billing_class":"facility"},{"gross_charge":50.5,"setting":"both","billing_class":"professional"}]},{"description":"T3 FREE","code_information":[{"code":"3004400","type":"CDM"},{"code":"301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"setting":"both","billing_class":"facility"},{"gross_charge":157.5,"setting":"both","billing_class":"professional"}]},{"description":"PSA FREE","code_information":[{"code":"3004405","type":"CDM"},{"code":"300","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"facility"},{"gross_charge":123.0,"setting":"both","billing_class":"professional"}]},{"description":"FRANCISELLA ABS X 2","code_information":[{"code":"3004407","type":"CDM"},{"code":"300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.75,"setting":"both","billing_class":"facility"},{"gross_charge":100.0,"setting":"both","billing_class":"professional"}]},{"description":"THYROXINE FREE","code_information":[{"code":"3004420","type":"CDM"},{"code":"301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.5,"setting":"both","billing_class":"facility"},{"gross_charge":177.25,"setting":"both","billing_class":"professional"}]},{"description":"FRUCTOSAMINE","code_information":[{"code":"3004456","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"FSH","code_information":[{"code":"3004460","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"setting":"both","billing_class":"facility"},{"gross_charge":342.25,"setting":"both","billing_class":"professional"}]},{"description":"GABAPENTIN","code_information":[{"code":"3004472","type":"CDM"},{"code":"300","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"GAMMA GLUTAMYL TRANSFERASE","code_information":[{"code":"3004482","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"GASTRIN","code_information":[{"code":"3004499","type":"CDM"},{"code":"301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.5,"setting":"both","billing_class":"facility"},{"gross_charge":252.25,"setting":"both","billing_class":"professional"}]},{"description":"GENTAMICIN","code_information":[{"code":"3004520","type":"CDM"},{"code":"301","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","billing_class":"facility"},{"gross_charge":168.25,"setting":"both","billing_class":"professional"}]},{"description":"GIARDIA ANTIGEN","code_information":[{"code":"3004546","type":"CDM"},{"code":"300","type":"RC"},{"code":"87269","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONAB X 4","code_information":[{"code":"3004558","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"setting":"both","billing_class":"facility"},{"gross_charge":317.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCAGON","code_information":[{"code":"3004561","type":"CDM"},{"code":"301","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"setting":"both","billing_class":"facility"},{"gross_charge":66.0,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE GLUCOMETER","code_information":[{"code":"3004585","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"}]},{"description":"1 HR GLUCOSE TOLERANCE  NO FBS","code_information":[{"code":"3004590","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"},{"gross_charge":194.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE TOLERANCE-3 SPECIMEN","code_information":[{"code":"3004602","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.5,"setting":"both","billing_class":"facility"},{"gross_charge":212.75,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE TOLERANCE ADDL","code_information":[{"code":"3004603","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"setting":"both","billing_class":"facility"},{"gross_charge":113.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE TOLERANCE ADDL X 2","code_information":[{"code":"3004604","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":225.75,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE TOLERANCE ADDL X 3","code_information":[{"code":"3004621","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.25,"setting":"both","billing_class":"facility"},{"gross_charge":338.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE TOLERANCE ADDL X 4","code_information":[{"code":"3004642","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.75,"setting":"both","billing_class":"facility"},{"gross_charge":450.75,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE  FLUID NOT BLOOD","code_information":[{"code":"3004719","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE  QUAN BLOOD","code_information":[{"code":"3004800","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.5,"setting":"both","billing_class":"facility"},{"gross_charge":53.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE-6-PD","code_information":[{"code":"3004879","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.25,"setting":"both","billing_class":"facility"},{"gross_charge":188.75,"setting":"both","billing_class":"professional"}]},{"description":"GLUTATHIONE","code_information":[{"code":"3004881","type":"CDM"},{"code":"300","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"facility"},{"gross_charge":87.0,"setting":"both","billing_class":"professional"}]},{"description":"GALACTOSE  PLASMA","code_information":[{"code":"3004901","type":"CDM"},{"code":"300","type":"RC"},{"code":"82760","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"setting":"both","billing_class":"facility"},{"gross_charge":121.75,"setting":"both","billing_class":"professional"}]},{"description":"GLYCOHEMOGLOBIN (A1C)","code_information":[{"code":"3004920","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":135.0,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"GRAM STAIN","code_information":[{"code":"3004960","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.0,"setting":"both","billing_class":"professional"}]},{"description":"HERPES 6 AMPLIF NA PROBE","code_information":[{"code":"3004967","type":"CDM"},{"code":"300","type":"RC"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.75,"setting":"both","billing_class":"facility"},{"gross_charge":107.75,"setting":"both","billing_class":"professional"}]},{"description":"HELICOBACTOR PYLORI STOOL","code_information":[{"code":"3004974","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.5,"setting":"both","billing_class":"facility"},{"gross_charge":216.0,"setting":"both","billing_class":"professional"}]},{"description":"H INFLUENZAE B Ab IgG","code_information":[{"code":"3004979","type":"CDM"},{"code":"300","type":"RC"},{"code":"86684","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"setting":"both","billing_class":"facility"},{"gross_charge":85.5,"setting":"both","billing_class":"professional"}]},{"description":"MORPHOMETRIC ANALYSIS /SPECIM","code_information":[{"code":"3005002","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.25,"setting":"both","billing_class":"facility"},{"gross_charge":472.25,"setting":"both","billing_class":"professional"}]},{"description":"INFECT AGENT DET-C DIFFICILE","code_information":[{"code":"3005005","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"},{"gross_charge":108.5,"setting":"both","billing_class":"professional"}]},{"description":"MORPHOMETRIC ANALYSIS/MANUAL","code_information":[{"code":"3005006","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"setting":"both","billing_class":"facility"},{"gross_charge":292.0,"setting":"both","billing_class":"professional"}]},{"description":"HAPTOGLOBIN","code_information":[{"code":"3005008","type":"CDM"},{"code":"301","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.75,"setting":"both","billing_class":"facility"},{"gross_charge":151.0,"setting":"both","billing_class":"professional"}]},{"description":"HCG QUANTITATIVE","code_information":[{"code":"3005026","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.5,"setting":"both","billing_class":"facility"},{"gross_charge":35.5,"setting":"both","billing_class":"professional"}]},{"description":"HCG SERUM","code_information":[{"code":"3005040","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.75,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"HDL CHOLESTEROL","code_information":[{"code":"3005060","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","billing_class":"professional"}]},{"description":"HELICOBACTER PYLORI X 3","code_information":[{"code":"3005062","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"setting":"both","billing_class":"facility"},{"gross_charge":250.75,"setting":"both","billing_class":"professional"}]},{"description":"HELICOBACTER PYLORI","code_information":[{"code":"3005069","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.75,"setting":"both","billing_class":"facility"},{"gross_charge":84.0,"setting":"both","billing_class":"professional"}]},{"description":"HUMAN EPIDIDYMIS PROT 4 (HE4)","code_information":[{"code":"3005072","type":"CDM"},{"code":"302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.0,"setting":"both","billing_class":"professional"}]},{"description":"HISTAMINE PLASMA","code_information":[{"code":"3005079","type":"CDM"},{"code":"300","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"}]},{"description":"HEMATOCRIT","code_information":[{"code":"3005080","type":"CDM"},{"code":"305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.25,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"HEMOGLOBIN PLASMA","code_information":[{"code":"3005087","type":"CDM"},{"code":"300","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.75,"setting":"both","billing_class":"facility"},{"gross_charge":53.5,"setting":"both","billing_class":"professional"}]},{"description":"HGB SICKLING SCREEN","code_information":[{"code":"3005096","type":"CDM"},{"code":"300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPARIN ANTI-XA ASSAY","code_information":[{"code":"3005124","type":"CDM"},{"code":"300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.5,"setting":"both","billing_class":"facility"},{"gross_charge":160.5,"setting":"both","billing_class":"professional"}]},{"description":"HEPATIC FUNCTION PANEL","code_information":[{"code":"3005131","type":"CDM"},{"code":"300","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.75,"setting":"both","billing_class":"facility"},{"gross_charge":192.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS PANEL ACUTE MH","code_information":[{"code":"3005138","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.25,"setting":"both","billing_class":"facility"},{"gross_charge":904.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS A AB IGM-MH","code_information":[{"code":"3005144","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.5,"setting":"both","billing_class":"facility"},{"gross_charge":125.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B CORE AB","code_information":[{"code":"3005145","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.25,"setting":"both","billing_class":"facility"},{"gross_charge":148.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B SURFACE AB","code_information":[{"code":"3005147","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"setting":"both","billing_class":"facility"},{"gross_charge":191.0,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B CORE IgM","code_information":[{"code":"3005148","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.25,"setting":"both","billing_class":"facility"},{"gross_charge":73.0,"setting":"both","billing_class":"professional"}]},{"description":"OVARIAN MALIGNANCY RISK","code_information":[{"code":"3005153","type":"CDM"},{"code":"300","type":"RC"},{"code":"81500","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"setting":"both","billing_class":"facility"},{"gross_charge":545.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B VIRUS","code_information":[{"code":"3005173","type":"CDM"},{"code":"300","type":"RC"},{"code":"87516","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"HIV 1 AB","code_information":[{"code":"3005174","type":"CDM"},{"code":"302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.75,"setting":"both","billing_class":"facility"},{"gross_charge":36.5,"setting":"both","billing_class":"professional"}]},{"description":"HERPES SIMPLEX VIR I IGG","code_information":[{"code":"3005197","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.5,"setting":"both","billing_class":"facility"},{"gross_charge":82.25,"setting":"both","billing_class":"professional"}]},{"description":"HERPES SIMPLEX VIR II IGG","code_information":[{"code":"3005198","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.75,"setting":"both","billing_class":"facility"},{"gross_charge":183.0,"setting":"both","billing_class":"professional"}]},{"description":"HERPES SIMPLEX AB","code_information":[{"code":"3005199","type":"CDM"},{"code":"300","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"HERPES S AMPLIF NA","code_information":[{"code":"3005207","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B DNA QUANT","code_information":[{"code":"3005219","type":"CDM"},{"code":"300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.25,"setting":"both","billing_class":"facility"},{"gross_charge":336.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B ANTIBODY","code_information":[{"code":"3005221","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.75,"setting":"both","billing_class":"facility"},{"gross_charge":94.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS ANTIGEN","code_information":[{"code":"3005222","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"setting":"both","billing_class":"facility"},{"gross_charge":55.5,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS B SURFACE AG","code_information":[{"code":"3005224","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"setting":"both","billing_class":"facility"},{"gross_charge":170.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS A AB TOTAL","code_information":[{"code":"3005228","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"setting":"both","billing_class":"facility"},{"gross_charge":207.0,"setting":"both","billing_class":"professional"}]},{"description":"HUMAN GROWTH HORMONE","code_information":[{"code":"3005236","type":"CDM"},{"code":"300","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.5,"setting":"both","billing_class":"facility"},{"gross_charge":275.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS C VIRUS AB","code_information":[{"code":"3005237","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.25,"setting":"both","billing_class":"facility"},{"gross_charge":146.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS C VIRUS AB","code_information":[{"code":"3005240","type":"CDM"},{"code":"300","type":"RC"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"facility"},{"gross_charge":78.5,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS C QUANT","code_information":[{"code":"3005247","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.25,"setting":"both","billing_class":"facility"},{"gross_charge":364.0,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS C DNA OR RNA","code_information":[{"code":"3005251","type":"CDM"},{"code":"300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.75,"setting":"both","billing_class":"facility"},{"gross_charge":824.25,"setting":"both","billing_class":"professional"}]},{"description":"HIV 2 AB","code_information":[{"code":"3005252","type":"CDM"},{"code":"302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"setting":"both","billing_class":"facility"},{"gross_charge":67.75,"setting":"both","billing_class":"professional"}]},{"description":"HIV-1 RNA","code_information":[{"code":"3005255","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.5,"setting":"both","billing_class":"facility"},{"gross_charge":1180.75,"setting":"both","billing_class":"professional"}]},{"description":"HISTOPLASMA AB X 2","code_information":[{"code":"3005291","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"HISTOPLASMA AB X 3","code_information":[{"code":"3005293","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"setting":"both","billing_class":"facility"},{"gross_charge":290.75,"setting":"both","billing_class":"professional"}]},{"description":"HOMOCYSTINE","code_information":[{"code":"3005312","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"facility"},{"gross_charge":254.25,"setting":"both","billing_class":"professional"}]},{"description":"HOMOVANILLIC ACID","code_information":[{"code":"3005317","type":"CDM"},{"code":"300","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"HGB CHROMATOGRAPHY","code_information":[{"code":"3005327","type":"CDM"},{"code":"300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"setting":"both","billing_class":"facility"},{"gross_charge":117.0,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY IGA/IGG/IGM EA","code_information":[{"code":"3005337","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":47.5,"setting":"both","billing_class":"professional"}]},{"description":"ID ARTHOPOD","code_information":[{"code":"3005341","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"setting":"both","billing_class":"facility"},{"gross_charge":54.75,"setting":"both","billing_class":"professional"}]},{"description":"ID PARASITE  WORM","code_information":[{"code":"3005342","type":"CDM"},{"code":"300","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.5,"setting":"both","billing_class":"facility"},{"gross_charge":57.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNE COMPLEX ASSAY","code_information":[{"code":"3005345","type":"CDM"},{"code":"302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.5,"setting":"both","billing_class":"facility"},{"gross_charge":56.5,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY IGA/IGG/IGM EA X 2","code_information":[{"code":"3005346","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.5,"setting":"both","billing_class":"facility"},{"gross_charge":94.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOFIXATION URINE","code_information":[{"code":"3005349","type":"CDM"},{"code":"302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.25,"setting":"both","billing_class":"facility"},{"gross_charge":146.25,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOFIXATION SERUM","code_information":[{"code":"3005350","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"IGG X 4","code_information":[{"code":"3005353","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.25,"setting":"both","billing_class":"facility"},{"gross_charge":342.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRUS AB NES X 2","code_information":[{"code":"3005358","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.25,"setting":"both","billing_class":"facility"},{"gross_charge":130.5,"setting":"both","billing_class":"professional"}]},{"description":"VIRUS AB NES","code_information":[{"code":"3005359","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","billing_class":"professional"}]},{"description":"HISTOPLASMA AB","code_information":[{"code":"3005364","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":97.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY QUANT NONAB","code_information":[{"code":"3005371","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"setting":"both","billing_class":"facility"},{"gross_charge":66.75,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOGLOBULIN E","code_information":[{"code":"3005381","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.5,"setting":"both","billing_class":"facility"},{"gross_charge":264.5,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY IGA/IGG/IGM EA X 3","code_information":[{"code":"3005382","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.25,"setting":"both","billing_class":"facility"},{"gross_charge":142.0,"setting":"both","billing_class":"professional"}]},{"description":"HPV-HIGH RISK","code_information":[{"code":"3005392","type":"CDM"},{"code":"306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"setting":"both","billing_class":"facility"},{"gross_charge":422.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOFLUORESC DIRECT","code_information":[{"code":"3005405","type":"CDM"},{"code":"310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"setting":"both","billing_class":"facility"},{"gross_charge":340.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONAB X 9","code_information":[{"code":"3005410","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.25,"setting":"both","billing_class":"facility"},{"gross_charge":715.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNE COMPLEX ASSAY X 2","code_information":[{"code":"3005418","type":"CDM"},{"code":"302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"setting":"both","billing_class":"facility"},{"gross_charge":111.75,"setting":"both","billing_class":"professional"}]},{"description":"TESTOSTERONE BIOAVAILABLE","code_information":[{"code":"3005420","type":"CDM"},{"code":"301","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.25,"setting":"both","billing_class":"facility"},{"gross_charge":134.0,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA A AG","code_information":[{"code":"3005423","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.25,"setting":"both","billing_class":"facility"},{"gross_charge":253.75,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA B AG (59)","code_information":[{"code":"3005424","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.75,"setting":"both","billing_class":"professional"},{"gross_charge":288.25,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"INFLUENZA VIRUS AB","code_information":[{"code":"3005425","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.75,"setting":"both","billing_class":"facility"},{"gross_charge":41.75,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA TYPE AB X 2","code_information":[{"code":"3005431","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"INSULIN FREE","code_information":[{"code":"3005438","type":"CDM"},{"code":"300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.25,"setting":"both","billing_class":"professional"}]},{"description":"INSULIN","code_information":[{"code":"3005441","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"INSULIN ANTIBODIES","code_information":[{"code":"3005443","type":"CDM"},{"code":"300","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.25,"setting":"both","billing_class":"facility"},{"gross_charge":103.0,"setting":"both","billing_class":"professional"}]},{"description":"INHIBIN A","code_information":[{"code":"3005444","type":"CDM"},{"code":"300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.25,"setting":"both","billing_class":"facility"},{"gross_charge":96.25,"setting":"both","billing_class":"professional"}]},{"description":"INSULIN-LIKE GROWTH FACTOR","code_information":[{"code":"3005451","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"setting":"both","billing_class":"facility"},{"gross_charge":487.0,"setting":"both","billing_class":"professional"}]},{"description":"INTRINSIC FACTOR ABS","code_information":[{"code":"3005452","type":"CDM"},{"code":"300","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"setting":"both","billing_class":"facility"},{"gross_charge":110.0,"setting":"both","billing_class":"professional"}]},{"description":"VIRAL CULTURE RAPID","code_information":[{"code":"3005469","type":"CDM"},{"code":"300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"setting":"both","billing_class":"facility"},{"gross_charge":52.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB  TITRX3-SENDOUT","code_information":[{"code":"3005470","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.75,"setting":"both","billing_class":"facility"},{"gross_charge":17.25,"setting":"both","billing_class":"professional"}]},{"description":"HISTOPLASMA CAPSUL AG IA","code_information":[{"code":"3005472","type":"CDM"},{"code":"300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"setting":"both","billing_class":"facility"},{"gross_charge":168.75,"setting":"both","billing_class":"professional"}]},{"description":"ISLET CELL AB","code_information":[{"code":"3005485","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.75,"setting":"both","billing_class":"facility"},{"gross_charge":135.25,"setting":"both","billing_class":"professional"}]},{"description":"NEPHELOMETRY EACH ANALYTE X 2","code_information":[{"code":"3005487","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.5,"setting":"both","billing_class":"facility"},{"gross_charge":581.75,"setting":"both","billing_class":"professional"}]},{"description":"KETOSTEROIDS","code_information":[{"code":"3005496","type":"CDM"},{"code":"300","type":"RC"},{"code":"83586","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.25,"setting":"both","billing_class":"facility"},{"gross_charge":65.25,"setting":"both","billing_class":"professional"}]},{"description":"HEPATITIS C RNA NAA QUAL","code_information":[{"code":"3005497","type":"CDM"},{"code":"300","type":"RC"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"setting":"both","billing_class":"facility"},{"gross_charge":93.0,"setting":"both","billing_class":"professional"}]},{"description":"KLEIHAUER-BETKE FETAL HGB","code_information":[{"code":"3005498","type":"CDM"},{"code":"305","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.25,"setting":"both","billing_class":"facility"},{"gross_charge":88.75,"setting":"both","billing_class":"professional"}]},{"description":"KOH PREP FOR SKIN HAIR NAIL","code_information":[{"code":"3005501","type":"CDM"},{"code":"300","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.25,"setting":"both","billing_class":"facility"},{"gross_charge":122.5,"setting":"both","billing_class":"professional"}]},{"description":"SENSITIVITY DISK","code_information":[{"code":"3005509","type":"CDM"},{"code":"306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"facility"},{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"AG DETECTION NOS","code_information":[{"code":"3005516","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","billing_class":"professional"}]},{"description":"LACTIC ACID","code_information":[{"code":"3005520","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"facility"},{"gross_charge":254.25,"setting":"both","billing_class":"professional"}]},{"description":"FETAL HGB SCREEN","code_information":[{"code":"3005523","type":"CDM"},{"code":"305","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"setting":"both","billing_class":"facility"},{"gross_charge":29.0,"setting":"both","billing_class":"professional"}]},{"description":"INSULIN X3","code_information":[{"code":"3005524","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.75,"setting":"both","billing_class":"facility"},{"gross_charge":205.75,"setting":"both","billing_class":"professional"}]},{"description":"CALIF AB LACROSSE","code_information":[{"code":"3005535","type":"CDM"},{"code":"300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"LACTOFERRIN FECAL","code_information":[{"code":"3005536","type":"CDM"},{"code":"300","type":"RC"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"},{"gross_charge":76.25,"setting":"both","billing_class":"professional"}]},{"description":"HERPES S AMPLIF X 2","code_information":[{"code":"3005537","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.75,"setting":"both","billing_class":"facility"},{"gross_charge":215.25,"setting":"both","billing_class":"professional"}]},{"description":"GLUCOSE  BLOOD X 3","code_information":[{"code":"3005541","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":159.0,"setting":"both","billing_class":"professional"}]},{"description":"LAMOTRIGINE","code_information":[{"code":"3005552","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"LDH","code_information":[{"code":"3005560","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"LD ISOENZYMES","code_information":[{"code":"3005584","type":"CDM"},{"code":"300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"SUGARS SINGLE QUAL EA SPEC","code_information":[{"code":"3005586","type":"CDM"},{"code":"300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":26.0,"setting":"both","billing_class":"professional"}]},{"description":"HBV GENOTYPE","code_information":[{"code":"3005588","type":"CDM"},{"code":"306","type":"RC"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.5,"setting":"both","billing_class":"facility"},{"gross_charge":563.5,"setting":"both","billing_class":"professional"}]},{"description":"INFECT AGENT DETECT TQ 12-25","code_information":[{"code":"3005589","type":"CDM"},{"code":"306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.75,"setting":"both","billing_class":"facility"},{"gross_charge":835.0,"setting":"both","billing_class":"professional"}]},{"description":"CALRETICULIN MUTATION ANALYSIS","code_information":[{"code":"3005601","type":"CDM"},{"code":"310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.75,"setting":"both","billing_class":"facility"},{"gross_charge":441.0,"setting":"both","billing_class":"professional"}]},{"description":"LDL CHOLESTEROL DIRECT","code_information":[{"code":"3005691","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":80.0,"setting":"both","billing_class":"professional"}]},{"description":"LIPID PROFILE","code_information":[{"code":"3005701","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"facility"},{"gross_charge":207.75,"setting":"both","billing_class":"professional"}]},{"description":"LIPID PROFILE (QW)","code_information":[{"code":"3005703","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.75,"setting":"both","billing_class":"facility"},{"gross_charge":207.75,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"LEAD BLOOD","code_information":[{"code":"3005722","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.0,"setting":"both","billing_class":"professional"}]},{"description":"LEAD STANDARD PROFILE","code_information":[{"code":"3005724","type":"CDM"},{"code":"300","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.25,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"LEGIONELLA AB SERUM","code_information":[{"code":"3005759","type":"CDM"},{"code":"300","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.75,"setting":"both","billing_class":"facility"},{"gross_charge":282.25,"setting":"both","billing_class":"professional"}]},{"description":"LEPTOSPIRA AB","code_information":[{"code":"3005765","type":"CDM"},{"code":"300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.25,"setting":"both","billing_class":"facility"},{"gross_charge":45.0,"setting":"both","billing_class":"professional"}]},{"description":"LEUKOCYTE ALK PHOS","code_information":[{"code":"3005800","type":"CDM"},{"code":"305","type":"RC"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"setting":"both","billing_class":"facility"},{"gross_charge":241.0,"setting":"both","billing_class":"professional"}]},{"description":"LEUKOCYTE HISTAMINE RELEASE","code_information":[{"code":"3005802","type":"CDM"},{"code":"300","type":"RC"},{"code":"86343","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.5,"setting":"both","billing_class":"professional"}]},{"description":"LEVETIRACETAM SERUM","code_information":[{"code":"3005806","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"LIPASE","code_information":[{"code":"3005840","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"setting":"both","billing_class":"facility"},{"gross_charge":168.75,"setting":"both","billing_class":"professional"}]},{"description":"LIPOPROTEIN-A","code_information":[{"code":"3005843","type":"CDM"},{"code":"300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"LISTERIA AB","code_information":[{"code":"3005856","type":"CDM"},{"code":"300","type":"RC"},{"code":"86723","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","billing_class":"facility"},{"gross_charge":139.0,"setting":"both","billing_class":"professional"}]},{"description":"CRYPTOSPORIDIUM AG","code_information":[{"code":"3005859","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"LITHIUM","code_information":[{"code":"3005860","type":"CDM"},{"code":"301","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.25,"setting":"both","billing_class":"facility"},{"gross_charge":148.75,"setting":"both","billing_class":"professional"}]},{"description":"HLA I TYPING 1 LOCUS HR","code_information":[{"code":"3005903","type":"CDM"},{"code":"300","type":"RC"},{"code":"81380","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"setting":"both","billing_class":"facility"},{"gross_charge":540.0,"setting":"both","billing_class":"professional"}]},{"description":"HANDLING FEE-QUEST","code_information":[{"code":"3005911","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":12.5,"setting":"both","billing_class":"facility"},{"gross_charge":10.5,"setting":"both","billing_class":"professional"}]},{"description":"LYMPHOCYTE MITOGEN","code_information":[{"code":"3005914","type":"CDM"},{"code":"300","type":"RC"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.25,"setting":"both","billing_class":"facility"},{"gross_charge":149.75,"setting":"both","billing_class":"professional"}]},{"description":"LUTEINIZING HORMONE","code_information":[{"code":"3005920","type":"CDM"},{"code":"301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.75,"setting":"both","billing_class":"facility"},{"gross_charge":389.75,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE AB CONFIRM X 2","code_information":[{"code":"3005935","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.25,"setting":"both","billing_class":"facility"},{"gross_charge":381.5,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE AB CONFIRM","code_information":[{"code":"3005936","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.25,"setting":"both","billing_class":"facility"},{"gross_charge":191.0,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE ANTIBODY","code_information":[{"code":"3005943","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.25,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE ANTIBODY X 2","code_information":[{"code":"3005944","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.25,"setting":"both","billing_class":"facility"},{"gross_charge":194.25,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE BY RAPID PCR","code_information":[{"code":"3005948","type":"CDM"},{"code":"300","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.5,"setting":"both","billing_class":"facility"},{"gross_charge":128.0,"setting":"both","billing_class":"professional"}]},{"description":"LYSOZYME","code_information":[{"code":"3005950","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"setting":"both","billing_class":"facility"},{"gross_charge":207.0,"setting":"both","billing_class":"professional"}]},{"description":"M TUBERCULOSIS BY QUANTIFE","code_information":[{"code":"3005952","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.5,"setting":"both","billing_class":"facility"}]},{"description":"M TUBERCULOSIS BY QUANTIFE","code_information":[{"code":"3005952","type":"CDM"},{"code":"300","type":"RC"},{"code":"86481","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.5,"setting":"both","billing_class":"professional"}]},{"description":"MAGNESIUM","code_information":[{"code":"3005960","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"MALARIA SMEARS  THICK/THIN","code_information":[{"code":"3005980","type":"CDM"},{"code":"306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"setting":"both","billing_class":"facility"},{"gross_charge":116.25,"setting":"both","billing_class":"professional"}]},{"description":"MANGANESE","code_information":[{"code":"3005990","type":"CDM"},{"code":"300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"facility"},{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"HLA II TYPING AG","code_information":[{"code":"3005994","type":"CDM"},{"code":"310","type":"RC"},{"code":"81375","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"},{"gross_charge":559.25,"setting":"both","billing_class":"professional"}]},{"description":"IA INFECTIOUS AGENT AB X 23","code_information":[{"code":"3005995","type":"CDM"},{"code":"302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1695.5,"setting":"both","billing_class":"facility"},{"gross_charge":1494.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONAB X 2","code_information":[{"code":"3005996","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.75,"setting":"both","billing_class":"facility"},{"gross_charge":159.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTIPHOSPHATIDYLSERINE X 3","code_information":[{"code":"3005997","type":"CDM"},{"code":"302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.25,"setting":"both","billing_class":"facility"},{"gross_charge":242.0,"setting":"both","billing_class":"professional"}]},{"description":"VOLATILES","code_information":[{"code":"3006006","type":"CDM"},{"code":"300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.25,"setting":"both","billing_class":"facility"},{"gross_charge":146.25,"setting":"both","billing_class":"professional"}]},{"description":"PAPPA SERUM","code_information":[{"code":"3006014","type":"CDM"},{"code":"300","type":"RC"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.75,"setting":"both","billing_class":"facility"},{"gross_charge":115.25,"setting":"both","billing_class":"professional"}]},{"description":"AUTOIMMUNE ANALYSIS-RHEUM ARTH","code_information":[{"code":"3006019","type":"CDM"},{"code":"310","type":"RC"},{"code":"81490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.25,"setting":"both","billing_class":"facility"},{"gross_charge":941.0,"setting":"both","billing_class":"professional"}]},{"description":"TRICHOMONAS VAGINALIS","code_information":[{"code":"3006021","type":"CDM"},{"code":"300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.25,"setting":"both","billing_class":"facility"},{"gross_charge":103.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LEVEL 3","code_information":[{"code":"3006022","type":"CDM"},{"code":"310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","billing_class":"facility"},{"gross_charge":366.5,"setting":"both","billing_class":"professional"}]},{"description":"CANDIDA NA DIRECT PROBE","code_information":[{"code":"3006023","type":"CDM"},{"code":"306","type":"RC"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":74.25,"setting":"both","billing_class":"professional"}]},{"description":"GARDNERELLA DIR NA PROBE","code_information":[{"code":"3006024","type":"CDM"},{"code":"306","type":"RC"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":74.25,"setting":"both","billing_class":"professional"}]},{"description":"TRICHOMONAS VAGIN DIR PROBE","code_information":[{"code":"3006026","type":"CDM"},{"code":"306","type":"RC"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":74.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO 100-300cell","code_information":[{"code":"3006035","type":"CDM"},{"code":"311","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"setting":"both","billing_class":"facility"},{"gross_charge":184.0,"setting":"both","billing_class":"professional"}]},{"description":"MERCURY QUANT","code_information":[{"code":"3006048","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"facility"},{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"METANEPHRINES","code_information":[{"code":"3006057","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"facility"},{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"METHEMOGLOBIN","code_information":[{"code":"3006080","type":"CDM"},{"code":"301","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"setting":"both","billing_class":"facility"},{"gross_charge":187.5,"setting":"both","billing_class":"professional"}]},{"description":"QUANTITATIVE ASSAY DRUG","code_information":[{"code":"3006090","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.5,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LEVEL 7","code_information":[{"code":"3006093","type":"CDM"},{"code":"310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.5,"setting":"both","billing_class":"facility"},{"gross_charge":736.75,"setting":"both","billing_class":"professional"}]},{"description":"GROWTH HORMONE(HGH) AB","code_information":[{"code":"3006095","type":"CDM"},{"code":"300","type":"RC"},{"code":"86277","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB X 3","code_information":[{"code":"3006096","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.75,"setting":"both","billing_class":"facility"},{"gross_charge":238.25,"setting":"both","billing_class":"professional"}]},{"description":"LUTEINIZING RELEASING FACTOR","code_information":[{"code":"3006097","type":"CDM"},{"code":"300","type":"RC"},{"code":"83727","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.5,"setting":"both","billing_class":"professional"}]},{"description":"ORGANIC ACID SNGL QUANT","code_information":[{"code":"3006106","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"setting":"both","billing_class":"facility"},{"gross_charge":405.0,"setting":"both","billing_class":"professional"}]},{"description":"MICROBE SUSCEPTIBLE STDY","code_information":[{"code":"3006155","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.25,"setting":"both","billing_class":"facility"},{"gross_charge":176.0,"setting":"both","billing_class":"professional"}]},{"description":"PT SUBSTITUTION PLASMA","code_information":[{"code":"3006161","type":"CDM"},{"code":"300","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTOGENETICS","code_information":[{"code":"3006168","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"MONOSCREEN","code_information":[{"code":"3006180","type":"CDM"},{"code":"302","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.75,"setting":"both","billing_class":"facility"},{"gross_charge":226.0,"setting":"both","billing_class":"professional"}]},{"description":"KRAS GENE","code_information":[{"code":"3006214","type":"CDM"},{"code":"310","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.5,"setting":"both","billing_class":"facility"},{"gross_charge":424.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTOGENETIC 25-99CEL","code_information":[{"code":"3006216","type":"CDM"},{"code":"300","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.75,"setting":"both","billing_class":"facility"},{"gross_charge":94.75,"setting":"both","billing_class":"professional"}]},{"description":"HEAVY METAL QUANT EACH NES","code_information":[{"code":"3006233","type":"CDM"},{"code":"300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"setting":"both","billing_class":"facility"},{"gross_charge":75.0,"setting":"both","billing_class":"professional"}]},{"description":"ENA ANY METHOD X 7","code_information":[{"code":"3006236","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"setting":"both","billing_class":"facility"},{"gross_charge":491.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LEVEL 5","code_information":[{"code":"3006237","type":"CDM"},{"code":"301","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.0,"setting":"both","billing_class":"facility"},{"gross_charge":694.75,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH UNLISTED X 6","code_information":[{"code":"3006238","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.5,"setting":"both","billing_class":"facility"},{"gross_charge":1101.0,"setting":"both","billing_class":"professional"}]},{"description":"MCAD DEFICIENCY FULL GENE ANL","code_information":[{"code":"3006239","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.25,"setting":"both","billing_class":"facility"},{"gross_charge":175.25,"setting":"both","billing_class":"professional"}]},{"description":"MUMPS AB","code_information":[{"code":"3006240","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","billing_class":"professional"}]},{"description":"MUMPS AB X 2","code_information":[{"code":"3006247","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":181.0,"setting":"both","billing_class":"professional"}]},{"description":"MYCOPLASMA AB","code_information":[{"code":"3006260","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"setting":"both","billing_class":"facility"},{"gross_charge":64.75,"setting":"both","billing_class":"professional"}]},{"description":"MYELIN BASIC PROTIEN","code_information":[{"code":"3006263","type":"CDM"},{"code":"300","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.5,"setting":"both","billing_class":"facility"},{"gross_charge":280.5,"setting":"both","billing_class":"professional"}]},{"description":"MYCOPHENOLIC ACID","code_information":[{"code":"3006264","type":"CDM"},{"code":"300","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"MYOGLBULIN","code_information":[{"code":"3006271","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.25,"setting":"both","billing_class":"facility"},{"gross_charge":146.25,"setting":"both","billing_class":"professional"}]},{"description":"MYCOPLASMA AB X 2","code_information":[{"code":"3006272","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"setting":"both","billing_class":"facility"},{"gross_charge":135.0,"setting":"both","billing_class":"professional"}]},{"description":"ENZYME ACTIVITY IN BLOOD CELLS","code_information":[{"code":"3006281","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.75,"setting":"both","billing_class":"facility"},{"gross_charge":244.75,"setting":"both","billing_class":"professional"}]},{"description":"AMPLIF NA PROBE AGENT X 2","code_information":[{"code":"3006295","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"setting":"both","billing_class":"facility"},{"gross_charge":215.5,"setting":"both","billing_class":"professional"}]},{"description":"NK CELLS COUNT","code_information":[{"code":"3006297","type":"CDM"},{"code":"300","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.25,"setting":"both","billing_class":"facility"},{"gross_charge":152.5,"setting":"both","billing_class":"professional"}]},{"description":"NICKEL ASSAY","code_information":[{"code":"3006310","type":"CDM"},{"code":"300","type":"RC"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"setting":"both","billing_class":"facility"},{"gross_charge":46.25,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD  NOT STOOL","code_information":[{"code":"3006345","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.75,"setting":"both","billing_class":"facility"},{"gross_charge":58.5,"setting":"both","billing_class":"professional"}]},{"description":"OBSTETRIC PANEL","code_information":[{"code":"3006351","type":"CDM"},{"code":"300","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.5,"setting":"both","billing_class":"facility"},{"gross_charge":1013.5,"setting":"both","billing_class":"professional"}]},{"description":"ORGANISM ID FUNGAL","code_information":[{"code":"3006357","type":"CDM"},{"code":"306","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.75,"setting":"both","billing_class":"facility"},{"gross_charge":95.75,"setting":"both","billing_class":"professional"}]},{"description":"ORGANISM ID BACTERIAL","code_information":[{"code":"3006358","type":"CDM"},{"code":"306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"OSMOLALITY SERUM","code_information":[{"code":"3006360","type":"CDM"},{"code":"301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","billing_class":"professional"}]},{"description":"ORGANISM ID ANEROBIC","code_information":[{"code":"3006362","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":130.25,"setting":"both","billing_class":"professional"}]},{"description":"ORGANISM ID AGGLUTIN","code_information":[{"code":"3006363","type":"CDM"},{"code":"300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":93.25,"setting":"both","billing_class":"professional"}]},{"description":"NEPHELOMETRY EACH ANALYTE","code_information":[{"code":"3006376","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.75,"setting":"both","billing_class":"facility"},{"gross_charge":291.25,"setting":"both","billing_class":"professional"}]},{"description":"LIPOPROTEIN QUAN","code_information":[{"code":"3006378","type":"CDM"},{"code":"300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.25,"setting":"both","billing_class":"facility"},{"gross_charge":104.0,"setting":"both","billing_class":"professional"}]},{"description":"OSMOLALITY URINE","code_information":[{"code":"3006380","type":"CDM"},{"code":"301","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD STOOL SCREEN MHC","code_information":[{"code":"3006382","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD STOOL","code_information":[{"code":"3006384","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD STOOL HGB","code_information":[{"code":"3006385","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"OSTEOCALCIN","code_information":[{"code":"3006390","type":"CDM"},{"code":"300","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.5,"setting":"both","billing_class":"facility"},{"gross_charge":79.5,"setting":"both","billing_class":"professional"}]},{"description":"OLIGCLONAL BANDING/SERUM","code_information":[{"code":"3006395","type":"CDM"},{"code":"300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.75,"setting":"both","billing_class":"facility"},{"gross_charge":111.5,"setting":"both","billing_class":"professional"}]},{"description":"OVA AND PARASITE EXAM","code_information":[{"code":"3006400","type":"CDM"},{"code":"306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.5,"setting":"both","billing_class":"facility"},{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"OXALATE","code_information":[{"code":"3006402","type":"CDM"},{"code":"300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.75,"setting":"both","billing_class":"facility"},{"gross_charge":218.25,"setting":"both","billing_class":"professional"}]},{"description":"OXCARBAZEPINE","code_information":[{"code":"3006407","type":"CDM"},{"code":"300","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"facility"},{"gross_charge":75.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL BLOOD COUNT (PBC)","code_information":[{"code":"3006419","type":"CDM"},{"code":"305","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"facility"},{"gross_charge":80.75,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL THROMBO TIME WHOLE BL","code_information":[{"code":"3006420","type":"CDM"},{"code":"305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"},{"gross_charge":108.5,"setting":"both","billing_class":"professional"}]},{"description":"PARVOVIRUS B19 AB X 2","code_information":[{"code":"3006446","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.5,"setting":"both","billing_class":"facility"},{"gross_charge":278.5,"setting":"both","billing_class":"professional"}]},{"description":"PARVOVIRUS B19 AB","code_information":[{"code":"3006447","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"PARTIAL BLOOD COUNT-MAB","code_information":[{"code":"3006449","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"PH FLUID","code_information":[{"code":"3006465","type":"CDM"},{"code":"300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"},{"gross_charge":65.0,"setting":"both","billing_class":"professional"}]},{"description":"OCCULT BLOOD, ICT","code_information":[{"code":"3006469","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"OCCULT BLOOD, ICT","code_information":[{"code":"3006469","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"NUCLEIC ACID;STREP B","code_information":[{"code":"3006476","type":"CDM"},{"code":"306","type":"RC"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"},{"gross_charge":108.5,"setting":"both","billing_class":"professional"}]},{"description":"H PYLORI BREATH TEST","code_information":[{"code":"3006477","type":"CDM"},{"code":"300","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.75,"setting":"both","billing_class":"facility"},{"gross_charge":195.0,"setting":"both","billing_class":"professional"}]},{"description":"H PYLORI ADMINISTRATION","code_information":[{"code":"3006478","type":"CDM"},{"code":"300","type":"RC"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.75,"setting":"both","billing_class":"facility"},{"gross_charge":29.5,"setting":"both","billing_class":"professional"}]},{"description":"ORGANIC ACID URINE","code_information":[{"code":"3006482","type":"CDM"},{"code":"300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"facility"},{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"ORGANISM ID  MOLD","code_information":[{"code":"3006487","type":"CDM"},{"code":"300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"setting":"both","billing_class":"facility"},{"gross_charge":117.0,"setting":"both","billing_class":"professional"}]},{"description":"SARS-COV-2 SEMI-QUAN ANTIB SPK","code_information":[{"code":"3006496","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.25,"setting":"both","billing_class":"facility"},{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"SARS-COV-2 ANTIBODY IgM","code_information":[{"code":"3006500","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.25,"setting":"both","billing_class":"facility"},{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"COVID 19 ANTIBODY","code_information":[{"code":"3006501","type":"CDM"},{"code":"300","type":"RC"},{"code":"86413","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.25,"setting":"both","billing_class":"facility"},{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"PHENOBARBITAL","code_information":[{"code":"3006502","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"setting":"both","billing_class":"facility"},{"gross_charge":71.25,"setting":"both","billing_class":"professional"}]},{"description":"CFTR GENE DUP/DELET VARIANT","code_information":[{"code":"3006503","type":"CDM"},{"code":"300","type":"RC"},{"code":"81222","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.25,"setting":"both","billing_class":"facility"},{"gross_charge":617.5,"setting":"both","billing_class":"professional"}]},{"description":"CFTR GENE FULL SEQUENCE","code_information":[{"code":"3006504","type":"CDM"},{"code":"300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.25,"setting":"both","billing_class":"facility"},{"gross_charge":707.75,"setting":"both","billing_class":"professional"}]},{"description":"HLA CLASS I&II AB","code_information":[{"code":"3006505","type":"CDM"},{"code":"300","type":"RC"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.25,"setting":"both","billing_class":"professional"}]},{"description":"CHOLINESTERASE PLASMA","code_information":[{"code":"3006506","type":"CDM"},{"code":"300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED IMMUNOLOGY PROC","code_information":[{"code":"3006507","type":"CDM"},{"code":"300","type":"RC"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"},{"gross_charge":225.0,"setting":"both","billing_class":"professional"}]},{"description":"RESP VIRUS 12-25 TARGETS","code_information":[{"code":"3006508","type":"CDM"},{"code":"306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.25,"setting":"both","billing_class":"facility"},{"gross_charge":563.25,"setting":"both","billing_class":"professional"}]},{"description":"CNS DNA AMP PROBE TYPE 12-25","code_information":[{"code":"3006509","type":"CDM"},{"code":"306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.25,"setting":"both","billing_class":"facility"},{"gross_charge":563.25,"setting":"both","billing_class":"professional"}]},{"description":"WARFARIN RESPONSE GENOTYPE","code_information":[{"code":"3006510","type":"CDM"},{"code":"300","type":"RC"},{"code":"0030U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.75,"setting":"both","billing_class":"facility"},{"gross_charge":945.0,"setting":"both","billing_class":"professional"}]},{"description":"COAGULATION FACTOR XIII","code_information":[{"code":"3006511","type":"CDM"},{"code":"300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.25,"setting":"both","billing_class":"facility"},{"gross_charge":299.75,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN NOS","code_information":[{"code":"3006512","type":"CDM"},{"code":"300","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.5,"setting":"both","billing_class":"facility"},{"gross_charge":146.5,"setting":"both","billing_class":"professional"}]},{"description":"NEISSERIA AMPLIF NA PROBE","code_information":[{"code":"3006514","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.25,"setting":"both","billing_class":"facility"},{"gross_charge":176.0,"setting":"both","billing_class":"professional"}]},{"description":"DNA/RNA AMPLIFIED PROBE X27","code_information":[{"code":"3006515","type":"CDM"},{"code":"306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2809.5,"setting":"both","billing_class":"facility"},{"gross_charge":2475.25,"setting":"both","billing_class":"professional"}]},{"description":"CIRCULATING TUMOR CELLS","code_information":[{"code":"3006517","type":"CDM"},{"code":"302","type":"RC"},{"code":"86152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"setting":"both","billing_class":"facility"},{"gross_charge":1089.75,"setting":"both","billing_class":"professional"}]},{"description":"MYCOPLASMA PNEUMONIAE","code_information":[{"code":"3006518","type":"CDM"},{"code":"300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.75,"setting":"both","billing_class":"facility"},{"gross_charge":92.25,"setting":"both","billing_class":"professional"}]},{"description":"COVID 19 AMPLIFIED PROBE","code_information":[{"code":"3006519","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.75,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":135.25,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"JCV AB","code_information":[{"code":"3006532","type":"CDM"},{"code":"300","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.75,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOFLUORESC AB ADDL STAIN","code_information":[{"code":"3006538","type":"CDM"},{"code":"310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.75,"setting":"both","billing_class":"facility"},{"gross_charge":48.0,"setting":"both","billing_class":"professional"}]},{"description":"PHENYLKETONURIA (PKU)","code_information":[{"code":"3006540","type":"CDM"},{"code":"300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.5,"setting":"both","billing_class":"facility"},{"gross_charge":442.5,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LEVEL 6","code_information":[{"code":"3006543","type":"CDM"},{"code":"300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.5,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOASSAY QUANT NONAB X 8","code_information":[{"code":"3006552","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"setting":"both","billing_class":"facility"},{"gross_charge":527.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY QUANT NONAB X 5","code_information":[{"code":"3006553","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.5,"setting":"both","billing_class":"facility"},{"gross_charge":329.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMILUMINESCENT ASSAY X3","code_information":[{"code":"3006554","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":130.25,"setting":"both","billing_class":"professional"}]},{"description":"PHENYTOIN TOTAL","code_information":[{"code":"3006560","type":"CDM"},{"code":"301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"setting":"both","billing_class":"facility"},{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LEVEL 2","code_information":[{"code":"3006561","type":"CDM"},{"code":"300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.25,"setting":"both","billing_class":"facility"},{"gross_charge":495.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH UNLISTED","code_information":[{"code":"3006562","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.25,"setting":"both","billing_class":"facility"},{"gross_charge":175.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH UNLISTED X 4","code_information":[{"code":"3006563","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.75,"setting":"both","billing_class":"facility"},{"gross_charge":734.5,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR V LEIDEN","code_information":[{"code":"3006564","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"setting":"both","billing_class":"facility"},{"gross_charge":203.5,"setting":"both","billing_class":"professional"}]},{"description":"MTHFR GENE","code_information":[{"code":"3006565","type":"CDM"},{"code":"300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.25,"setting":"both","billing_class":"facility"},{"gross_charge":442.25,"setting":"both","billing_class":"professional"}]},{"description":"DPYD GENE COMM VARIANTS","code_information":[{"code":"3006566","type":"CDM"},{"code":"310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"setting":"both","billing_class":"facility"},{"gross_charge":479.25,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR II GENE","code_information":[{"code":"3006567","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility"},{"gross_charge":219.25,"setting":"both","billing_class":"professional"}]},{"description":"HERED HEMOCHR DNA","code_information":[{"code":"3006568","type":"CDM"},{"code":"300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"setting":"both","billing_class":"facility"},{"gross_charge":593.5,"setting":"both","billing_class":"professional"}]},{"description":"HLA-B27","code_information":[{"code":"3006569","type":"CDM"},{"code":"300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"setting":"both","billing_class":"facility"},{"gross_charge":247.5,"setting":"both","billing_class":"professional"}]},{"description":"NPM1 MUTATION ANALYSIS","code_information":[{"code":"3006572","type":"CDM"},{"code":"310","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.5,"setting":"both","billing_class":"facility"},{"gross_charge":377.5,"setting":"both","billing_class":"professional"}]},{"description":"CYSTIC FIBROSIS PROFILE","code_information":[{"code":"3006573","type":"CDM"},{"code":"300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.25,"setting":"both","billing_class":"facility"},{"gross_charge":802.5,"setting":"both","billing_class":"professional"}]},{"description":"JAK2 GENE","code_information":[{"code":"3006574","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"setting":"both","billing_class":"facility"},{"gross_charge":368.0,"setting":"both","billing_class":"professional"}]},{"description":"T CELL GENE REARRANGEMENT","code_information":[{"code":"3006575","type":"CDM"},{"code":"300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.25,"setting":"both","billing_class":"facility"},{"gross_charge":505.5,"setting":"both","billing_class":"professional"}]},{"description":"FRAGILE X SYNDROME","code_information":[{"code":"3006576","type":"CDM"},{"code":"300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.25,"setting":"both","billing_class":"facility"},{"gross_charge":323.5,"setting":"both","billing_class":"professional"}]},{"description":"HLA II TYPING  LOW RESOLUTION","code_information":[{"code":"3006577","type":"CDM"},{"code":"300","type":"RC"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":457.5,"setting":"both","billing_class":"professional"}]},{"description":"HLA II TYPING  HIGH RESOLUTION","code_information":[{"code":"3006578","type":"CDM"},{"code":"300","type":"RC"},{"code":"81383","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.75,"setting":"both","billing_class":"facility"},{"gross_charge":472.75,"setting":"both","billing_class":"professional"}]},{"description":"PHENYTOIN FREE","code_information":[{"code":"3006580","type":"CDM"},{"code":"301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.5,"setting":"both","billing_class":"facility"},{"gross_charge":684.75,"setting":"both","billing_class":"professional"}]},{"description":"HLA I TYPING COMPLETE","code_information":[{"code":"3006582","type":"CDM"},{"code":"300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.75,"setting":"both","billing_class":"facility"},{"gross_charge":1106.25,"setting":"both","billing_class":"professional"}]},{"description":"FACTOR V DNA ANALYSIS","code_information":[{"code":"3006587","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"setting":"both","billing_class":"facility"},{"gross_charge":354.0,"setting":"both","billing_class":"professional"}]},{"description":"HSV CULTURE AND TYPING","code_information":[{"code":"3006588","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"setting":"both","billing_class":"facility"},{"gross_charge":89.75,"setting":"both","billing_class":"professional"}]},{"description":"CARDIOLIPIN AB IG CLASS X 2","code_information":[{"code":"3006597","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.25,"setting":"both","billing_class":"facility"},{"gross_charge":167.5,"setting":"both","billing_class":"professional"}]},{"description":"PHOSPHORUS","code_information":[{"code":"3006600","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":47.5,"setting":"both","billing_class":"professional"}]},{"description":"PLATELET AB ID","code_information":[{"code":"3006602","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"facility"},{"gross_charge":78.5,"setting":"both","billing_class":"professional"}]},{"description":"PHOSPHORUS  24 HR URINE","code_information":[{"code":"3006603","type":"CDM"},{"code":"300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOFLUORESC AB ADDL X 4","code_information":[{"code":"3006607","type":"CDM"},{"code":"310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.25,"setting":"both","billing_class":"facility"},{"gross_charge":190.0,"setting":"both","billing_class":"professional"}]},{"description":"FLT3 GENE","code_information":[{"code":"3006609","type":"CDM"},{"code":"310","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"},{"gross_charge":277.75,"setting":"both","billing_class":"professional"}]},{"description":"FLT3 GENE ANALYSIS","code_information":[{"code":"3006610","type":"CDM"},{"code":"310","type":"RC"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"TRB GENE REARRANGEMENT AMPLIFY","code_information":[{"code":"3006613","type":"CDM"},{"code":"310","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.5,"setting":"both","billing_class":"facility"},{"gross_charge":476.75,"setting":"both","billing_class":"professional"}]},{"description":"MRSA MR STAPH DNA AMP PROBE","code_information":[{"code":"3006614","type":"CDM"},{"code":"306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.75,"setting":"both","billing_class":"facility"},{"gross_charge":78.0,"setting":"both","billing_class":"professional"}]},{"description":"BRCA1&2 SEQ & FULL DUP/DEL","code_information":[{"code":"3006616","type":"CDM"},{"code":"310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":4524.0,"setting":"both","billing_class":"facility"},{"gross_charge":3986.0,"setting":"both","billing_class":"professional"}]},{"description":"IGH GENE REARRANGE AMP METH","code_information":[{"code":"3006617","type":"CDM"},{"code":"310","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.75,"setting":"both","billing_class":"facility"},{"gross_charge":433.0,"setting":"both","billing_class":"professional"}]},{"description":"PINWORM EXAM","code_information":[{"code":"3006620","type":"CDM"},{"code":"306","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.5,"setting":"both","billing_class":"facility"},{"gross_charge":49.5,"setting":"both","billing_class":"professional"}]},{"description":"IGK REARRANGEABN CLONAL POP","code_information":[{"code":"3006622","type":"CDM"},{"code":"310","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"setting":"both","billing_class":"facility"},{"gross_charge":325.75,"setting":"both","billing_class":"professional"}]},{"description":"PLASMINOGEN","code_information":[{"code":"3006625","type":"CDM"},{"code":"300","type":"RC"},{"code":"85421","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"setting":"both","billing_class":"facility"},{"gross_charge":19.25,"setting":"both","billing_class":"professional"}]},{"description":"PLASMINOGEN  PAI-1","code_information":[{"code":"3006628","type":"CDM"},{"code":"300","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.25,"setting":"both","billing_class":"facility"},{"gross_charge":105.0,"setting":"both","billing_class":"professional"}]},{"description":"PLATELET AB  IG ASSAY","code_information":[{"code":"3006636","type":"CDM"},{"code":"300","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.5,"setting":"both","billing_class":"facility"},{"gross_charge":34.5,"setting":"both","billing_class":"professional"}]},{"description":"ONCOLOGY TUM UNK ORIGIN","code_information":[{"code":"3006639","type":"CDM"},{"code":"310","type":"RC"},{"code":"81540","type":"HCPCS"}],"standard_charges":[{"gross_charge":5277.5,"setting":"both","billing_class":"facility"},{"gross_charge":4649.75,"setting":"both","billing_class":"professional"}]},{"description":"CHROMOSOME MICROARRAY","code_information":[{"code":"3006642","type":"CDM"},{"code":"310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.75,"setting":"both","billing_class":"facility"},{"gross_charge":1759.0,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROVIRUS AB X 3","code_information":[{"code":"3006661","type":"CDM"},{"code":"300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.5,"setting":"both","billing_class":"facility"},{"gross_charge":211.75,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNODIFFUSION  GEL DIFFUSION","code_information":[{"code":"3006671","type":"CDM"},{"code":"300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.25,"setting":"both","billing_class":"facility"},{"gross_charge":132.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTIBODY; ACTINOMYCES X 2","code_information":[{"code":"3006672","type":"CDM"},{"code":"300","type":"RC"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.75,"setting":"both","billing_class":"facility"},{"gross_charge":171.25,"setting":"both","billing_class":"professional"}]},{"description":"PANCREATIC ELASTASE 1","code_information":[{"code":"3006673","type":"CDM"},{"code":"300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.25,"setting":"both","billing_class":"facility"},{"gross_charge":335.75,"setting":"both","billing_class":"professional"}]},{"description":"BACTERIUM AB","code_information":[{"code":"3006674","type":"CDM"},{"code":"302","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.25,"setting":"both","billing_class":"facility"},{"gross_charge":59.0,"setting":"both","billing_class":"professional"}]},{"description":"ANTIBODY; ACTINOMYCES X 3","code_information":[{"code":"3006679","type":"CDM"},{"code":"300","type":"RC"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"facility"},{"gross_charge":85.75,"setting":"both","billing_class":"professional"}]},{"description":"PORPHOBILINOGEN UA","code_information":[{"code":"3006683","type":"CDM"},{"code":"300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"facility"},{"gross_charge":43.75,"setting":"both","billing_class":"professional"}]},{"description":"PORPHYRINS  SERUM","code_information":[{"code":"3006692","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"setting":"both","billing_class":"facility"},{"gross_charge":19.75,"setting":"both","billing_class":"professional"}]},{"description":"PORPHYRINS FECAL","code_information":[{"code":"3006695","type":"CDM"},{"code":"300","type":"RC"},{"code":"84126","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.25,"setting":"both","billing_class":"facility"},{"gross_charge":219.5,"setting":"both","billing_class":"professional"}]},{"description":"PORPHYRIN  QUANTITATIVE","code_information":[{"code":"3006697","type":"CDM"},{"code":"300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.5,"setting":"both","billing_class":"facility"},{"gross_charge":62.75,"setting":"both","billing_class":"professional"}]},{"description":"POTASSIUM  SERUM","code_information":[{"code":"3006698","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.75,"setting":"both","billing_class":"facility"},{"gross_charge":58.5,"setting":"both","billing_class":"professional"}]},{"description":"POTASSIUM  URINE","code_information":[{"code":"3006720","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.5,"setting":"both","billing_class":"facility"},{"gross_charge":101.75,"setting":"both","billing_class":"professional"}]},{"description":"PRE-ALBUMIN","code_information":[{"code":"3006742","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"facility"},{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"URINE PREGNANCY  QUALITATIVE","code_information":[{"code":"3006745","type":"CDM"},{"code":"307","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.25,"setting":"both","billing_class":"facility"},{"gross_charge":143.5,"setting":"both","billing_class":"professional"}]},{"description":"PREGNENOLONE","code_information":[{"code":"3006754","type":"CDM"},{"code":"300","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.75,"setting":"both","billing_class":"facility"},{"gross_charge":237.5,"setting":"both","billing_class":"professional"}]},{"description":"PRIMIDONE","code_information":[{"code":"3006762","type":"CDM"},{"code":"300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.5,"setting":"both","billing_class":"facility"},{"gross_charge":90.25,"setting":"both","billing_class":"professional"}]},{"description":"NATRIURETIC PEPTIDE","code_information":[{"code":"3006775","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.25,"setting":"both","billing_class":"facility"},{"gross_charge":376.25,"setting":"both","billing_class":"professional"}]},{"description":"PROCALCITONIN","code_information":[{"code":"3006776","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.75,"setting":"both","billing_class":"facility"},{"gross_charge":203.25,"setting":"both","billing_class":"professional"}]},{"description":"PROGESTERONEIN","code_information":[{"code":"3006803","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"facility"},{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"PROINSULIN","code_information":[{"code":"3006810","type":"CDM"},{"code":"300","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"setting":"both","billing_class":"facility"},{"gross_charge":436.0,"setting":"both","billing_class":"professional"}]},{"description":"PROLACTIN","code_information":[{"code":"3006820","type":"CDM"},{"code":"301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.75,"setting":"both","billing_class":"facility"},{"gross_charge":360.0,"setting":"both","billing_class":"professional"}]},{"description":"PSA SCREEN","code_information":[{"code":"3006862","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.25,"setting":"both","billing_class":"facility"}]},{"description":"PSA SCREEN","code_information":[{"code":"3006862","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":190.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN C ANTIGEN","code_information":[{"code":"3006903","type":"CDM"},{"code":"300","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.5,"setting":"both","billing_class":"facility"},{"gross_charge":137.75,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN C ACTIVITY","code_information":[{"code":"3006904","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"setting":"both","billing_class":"facility"},{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"ELECTROPHORESIS SERUM PROTEI","code_information":[{"code":"3006920","type":"CDM"},{"code":"300","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"setting":"both","billing_class":"facility"},{"gross_charge":80.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN S AG  TOTAL","code_information":[{"code":"3006982","type":"CDM"},{"code":"300","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"setting":"both","billing_class":"facility"},{"gross_charge":232.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN S  FREE","code_information":[{"code":"3006983","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.75,"setting":"both","billing_class":"facility"},{"gross_charge":183.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN  TOTAL OTHER SPEC","code_information":[{"code":"3006990","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"setting":"both","billing_class":"facility"},{"gross_charge":71.25,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN WESTERN BLOT","code_information":[{"code":"3006993","type":"CDM"},{"code":"300","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.75,"setting":"both","billing_class":"facility"},{"gross_charge":192.75,"setting":"both","billing_class":"professional"}]},{"description":"PROTHROMBIN TIME","code_information":[{"code":"3007000","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","billing_class":"facility"},{"gross_charge":76.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTHROMBIN-INF","code_information":[{"code":"3007002","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","billing_class":"facility"}]},{"description":"PROTHROMBIN TIME-ANTICOAG","code_information":[{"code":"3007004","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"COAG TIME ACTIVATED","code_information":[{"code":"3007006","type":"CDM"},{"code":"305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.5,"setting":"both","billing_class":"facility"},{"gross_charge":76.0,"setting":"both","billing_class":"professional"}]},{"description":"PSA TOTAL","code_information":[{"code":"3007035","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"setting":"both","billing_class":"facility"},{"gross_charge":93.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMILUMINESCENT ASSAY","code_information":[{"code":"3007043","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.5,"setting":"both","billing_class":"facility"},{"gross_charge":44.25,"setting":"both","billing_class":"professional"}]},{"description":"PTH  INTACT (IRMA)","code_information":[{"code":"3007060","type":"CDM"},{"code":"301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.25,"setting":"both","billing_class":"facility"},{"gross_charge":356.0,"setting":"both","billing_class":"professional"}]},{"description":"PYRUVATE (PYRUVIC ACID)","code_information":[{"code":"3007090","type":"CDM"},{"code":"300","type":"RC"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"COXIELLA BRUNETII AB","code_information":[{"code":"3007098","type":"CDM"},{"code":"300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.25,"setting":"both","billing_class":"facility"},{"gross_charge":73.0,"setting":"both","billing_class":"professional"}]},{"description":"COXIELLA BRUNETII AB X 4","code_information":[{"code":"3007102","type":"CDM"},{"code":"300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.75,"setting":"both","billing_class":"facility"},{"gross_charge":323.0,"setting":"both","billing_class":"professional"}]},{"description":"RHEUMATOID FACTOR","code_information":[{"code":"3007110","type":"CDM"},{"code":"302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.5,"setting":"both","billing_class":"facility"},{"gross_charge":226.0,"setting":"both","billing_class":"professional"}]},{"description":"RAPID PLASMA REAGIN","code_information":[{"code":"3007120","type":"CDM"},{"code":"302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.75,"setting":"both","billing_class":"facility"},{"gross_charge":22.5,"setting":"both","billing_class":"professional"}]},{"description":"RAPID STREP A  THROAT","code_information":[{"code":"3007122","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"setting":"both","billing_class":"facility"},{"gross_charge":151.25,"setting":"both","billing_class":"professional"}]},{"description":"FATTY ACID PROFILE","code_information":[{"code":"3007134","type":"CDM"},{"code":"300","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.25,"setting":"both","billing_class":"facility"},{"gross_charge":152.5,"setting":"both","billing_class":"professional"}]},{"description":"RENAL FAILURE PANEL","code_information":[{"code":"3007150","type":"CDM"},{"code":"300","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"setting":"both","billing_class":"facility"},{"gross_charge":284.5,"setting":"both","billing_class":"professional"}]},{"description":"RENIN ACTIVITY","code_information":[{"code":"3007161","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.25,"setting":"both","billing_class":"facility"},{"gross_charge":135.75,"setting":"both","billing_class":"professional"}]},{"description":"REPTILASE TIME","code_information":[{"code":"3007165","type":"CDM"},{"code":"300","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.5,"setting":"both","billing_class":"facility"},{"gross_charge":177.25,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB X 2","code_information":[{"code":"3007178","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"RETICULOCYTE COUNT-MANUAL","code_information":[{"code":"3007180","type":"CDM"},{"code":"305","type":"RC"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.5,"setting":"both","billing_class":"facility"},{"gross_charge":92.5,"setting":"both","billing_class":"professional"}]},{"description":"RH","code_information":[{"code":"3007190","type":"CDM"},{"code":"302","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"setting":"both","billing_class":"facility"},{"gross_charge":141.75,"setting":"both","billing_class":"professional"}]},{"description":"RHOGAM ONLY","code_information":[{"code":"3007205","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.75,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":689.5,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"RHOPHYLAC ONLY","code_information":[{"code":"3007206","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2791","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.75,"setting":"both","modifiers":"U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":196.75,"setting":"both","modifiers":"U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"VITAMIN B2","code_information":[{"code":"3007219","type":"CDM"},{"code":"300","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.25,"setting":"both","billing_class":"facility"},{"gross_charge":411.75,"setting":"both","billing_class":"professional"}]},{"description":"RISTOCETIN COFACTOR","code_information":[{"code":"3007221","type":"CDM"},{"code":"305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.75,"setting":"both","billing_class":"facility"},{"gross_charge":183.0,"setting":"both","billing_class":"professional"}]},{"description":"ROCKY MOUNTAIN SPOTTED FEVER T","code_information":[{"code":"3007224","type":"CDM"},{"code":"300","type":"RC"},{"code":"86318","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"facility"},{"gross_charge":144.5,"setting":"both","billing_class":"professional"}]},{"description":"ROTAVIRUS BY EIA","code_information":[{"code":"3007225","type":"CDM"},{"code":"306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","billing_class":"facility"},{"gross_charge":366.5,"setting":"both","billing_class":"professional"}]},{"description":"RSV BY EIA","code_information":[{"code":"3007230","type":"CDM"},{"code":"300","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.5,"setting":"both","billing_class":"facility"},{"gross_charge":329.75,"setting":"both","billing_class":"professional"}]},{"description":"RUBELLA AB","code_information":[{"code":"3007242","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"},{"gross_charge":247.25,"setting":"both","billing_class":"professional"}]},{"description":"RUBEOLA (MEASLES) AB","code_information":[{"code":"3007260","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.25,"setting":"both","billing_class":"facility"},{"gross_charge":137.25,"setting":"both","billing_class":"professional"}]},{"description":"RUBEOLA (MEASLES) AB X 2","code_information":[{"code":"3007261","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"setting":"both","billing_class":"facility"},{"gross_charge":274.0,"setting":"both","billing_class":"professional"}]},{"description":"SARS-COV-2/FLU/RSV","code_information":[{"code":"3007339","type":"CDM"},{"code":"300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.75,"setting":"both","billing_class":"facility"},{"gross_charge":372.5,"setting":"both","billing_class":"professional"}]},{"description":"SED RATE","code_information":[{"code":"3007340","type":"CDM"},{"code":"305","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"},{"gross_charge":76.25,"setting":"both","billing_class":"professional"}]},{"description":"SELENIUM","code_information":[{"code":"3007349","type":"CDM"},{"code":"300","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.5,"setting":"both","billing_class":"facility"},{"gross_charge":177.25,"setting":"both","billing_class":"professional"}]},{"description":"SEROTONIN SERUM","code_information":[{"code":"3007381","type":"CDM"},{"code":"300","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.75,"setting":"both","billing_class":"facility"},{"gross_charge":448.25,"setting":"both","billing_class":"professional"}]},{"description":"SEX HORMONE BINDING GLOBUL","code_information":[{"code":"3007386","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.5,"setting":"both","billing_class":"facility"},{"gross_charge":261.0,"setting":"both","billing_class":"professional"}]},{"description":"SGOT/AST","code_information":[{"code":"3007400","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.75,"setting":"both","billing_class":"facility"},{"gross_charge":88.25,"setting":"both","billing_class":"professional"}]},{"description":"SGPT/ALT","code_information":[{"code":"3007420","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.75,"setting":"both","billing_class":"facility"},{"gross_charge":88.25,"setting":"both","billing_class":"professional"}]},{"description":"LEGIONELLA PNEUMOPHILA AG UR","code_information":[{"code":"3007426","type":"CDM"},{"code":"306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"AGENT NOS ASSAY W/OPTIC","code_information":[{"code":"3007428","type":"CDM"},{"code":"306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"SIROLIMUS","code_information":[{"code":"3007445","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.5,"setting":"both","billing_class":"facility"},{"gross_charge":303.25,"setting":"both","billing_class":"professional"}]},{"description":"SODIUM","code_information":[{"code":"3007480","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"SODIUM OTHER SOURCE","code_information":[{"code":"3007490","type":"CDM"},{"code":"300","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":47.5,"setting":"both","billing_class":"professional"}]},{"description":"SODIUM  URINE","code_information":[{"code":"3007500","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.25,"setting":"both","billing_class":"facility"},{"gross_charge":47.5,"setting":"both","billing_class":"professional"}]},{"description":"INFLUENZA DNA AMPLIFIED PROBE","code_information":[{"code":"3007502","type":"CDM"},{"code":"306","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"professional"},{"gross_charge":409.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"SULFATE URINE","code_information":[{"code":"3007522","type":"CDM"},{"code":"300","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.75,"setting":"both","billing_class":"facility"},{"gross_charge":16.25,"setting":"both","billing_class":"professional"}]},{"description":"SOLUBLE TRANSFERRIN RECEP","code_information":[{"code":"3007531","type":"CDM"},{"code":"300","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.75,"setting":"both","billing_class":"facility"},{"gross_charge":271.0,"setting":"both","billing_class":"professional"}]},{"description":"SPERM POST VASECTOMY","code_information":[{"code":"3007600","type":"CDM"},{"code":"300","type":"RC"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"setting":"both","billing_class":"facility"},{"gross_charge":289.75,"setting":"both","billing_class":"professional"}]},{"description":"ST LOUIS ENCEPH AB","code_information":[{"code":"3007611","type":"CDM"},{"code":"300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"STAIN FOR WBC","code_information":[{"code":"3007621","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.75,"setting":"both","billing_class":"facility"},{"gross_charge":62.0,"setting":"both","billing_class":"professional"}]},{"description":"HPV GENOTYPES 16 18 45","code_information":[{"code":"3007628","type":"CDM"},{"code":"306","type":"RC"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"setting":"both","billing_class":"facility"},{"gross_charge":101.25,"setting":"both","billing_class":"professional"}]},{"description":"LACTOFERRIN FECAL","code_information":[{"code":"3007629","type":"CDM"},{"code":"301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.5,"setting":"both","billing_class":"facility"},{"gross_charge":73.25,"setting":"both","billing_class":"professional"}]},{"description":"STREP A AMPLIFIED PROBE","code_information":[{"code":"3007651","type":"CDM"},{"code":"306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"setting":"both","billing_class":"professional"},{"gross_charge":169.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"IA INFECTIOUS AGENT AB","code_information":[{"code":"3007691","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"setting":"both","billing_class":"facility"},{"gross_charge":88.0,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE  SCREEN MISC","code_information":[{"code":"3007739","type":"CDM"},{"code":"306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.5,"setting":"both","billing_class":"facility"},{"gross_charge":33.75,"setting":"both","billing_class":"professional"}]},{"description":"STREPTOZYME","code_information":[{"code":"3007750","type":"CDM"},{"code":"300","type":"RC"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.5,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TEST 8-14 CLASSES","code_information":[{"code":"3007774","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":175.0,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TEST 8-14 CLASSES","code_information":[{"code":"3007774","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.5,"setting":"both","billing_class":"facility"}]},{"description":"DRUG TEST 15-21 CLASSES","code_information":[{"code":"3007775","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.75,"setting":"both","billing_class":"facility"}]},{"description":"T CELL ABSOLUTE CD4/CD8","code_information":[{"code":"3007795","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.5,"setting":"both","billing_class":"facility"},{"gross_charge":235.5,"setting":"both","billing_class":"professional"}]},{"description":"T CELL TOTAL COUNT","code_information":[{"code":"3007796","type":"CDM"},{"code":"300","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"setting":"both","billing_class":"facility"},{"gross_charge":189.25,"setting":"both","billing_class":"professional"}]},{"description":"T3 UPTAKE","code_information":[{"code":"3007800","type":"CDM"},{"code":"301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.25,"setting":"both","billing_class":"facility"},{"gross_charge":33.5,"setting":"both","billing_class":"professional"}]},{"description":"RSV DNA/RNA AMPLIFIED PROBE","code_information":[{"code":"3007807","type":"CDM"},{"code":"306","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.25,"setting":"both","billing_class":"professional"},{"gross_charge":337.75,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"TESTOSTERONE","code_information":[{"code":"3007820","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"setting":"both","billing_class":"facility"},{"gross_charge":130.25,"setting":"both","billing_class":"professional"}]},{"description":"TESTOSTERONE BIOAVAIL","code_information":[{"code":"3007823","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"setting":"both","billing_class":"facility"},{"gross_charge":128.5,"setting":"both","billing_class":"professional"}]},{"description":"TETANUS TOXOID IGG AB","code_information":[{"code":"3007847","type":"CDM"},{"code":"300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.75,"setting":"both","billing_class":"facility"},{"gross_charge":77.25,"setting":"both","billing_class":"professional"}]},{"description":"THEOPHYLLINE","code_information":[{"code":"3007860","type":"CDM"},{"code":"301","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.5,"setting":"both","billing_class":"professional"}]},{"description":"THROMBIN CLOTTING TIME","code_information":[{"code":"3007940","type":"CDM"},{"code":"300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"setting":"both","billing_class":"facility"},{"gross_charge":111.0,"setting":"both","billing_class":"professional"}]},{"description":"THROMBOPLASTIN","code_information":[{"code":"3007942","type":"CDM"},{"code":"305","type":"RC"},{"code":"85705","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.75,"setting":"both","billing_class":"facility"},{"gross_charge":36.5,"setting":"both","billing_class":"professional"}]},{"description":"THYROGLOBULIN AB","code_information":[{"code":"3007961","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.5,"setting":"both","billing_class":"facility"},{"gross_charge":97.75,"setting":"both","billing_class":"professional"}]},{"description":"THYROGLOBULIN","code_information":[{"code":"3007965","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.0,"setting":"both","billing_class":"professional"}]},{"description":"MICROSOMAL AB EACH","code_information":[{"code":"3007993","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.25,"setting":"both","billing_class":"facility"},{"gross_charge":90.0,"setting":"both","billing_class":"professional"}]},{"description":"THYROID STIM IMMUNOGLOBUL","code_information":[{"code":"3007999","type":"CDM"},{"code":"300","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.25,"setting":"both","billing_class":"facility"},{"gross_charge":653.0,"setting":"both","billing_class":"professional"}]},{"description":"THYROID STIMULATING HORMONE","code_information":[{"code":"3008000","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"setting":"both","billing_class":"facility"},{"gross_charge":241.0,"setting":"both","billing_class":"professional"}]},{"description":"TRH STIMULATION PANEL","code_information":[{"code":"3008010","type":"CDM"},{"code":"300","type":"RC"},{"code":"80438","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"setting":"both","billing_class":"facility"},{"gross_charge":182.25,"setting":"both","billing_class":"professional"}]},{"description":"TISSUE CULTURE NON NEOPL","code_information":[{"code":"3008011","type":"CDM"},{"code":"311","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"setting":"both","billing_class":"facility"},{"gross_charge":307.25,"setting":"both","billing_class":"professional"}]},{"description":"THYROXINE BINDING GLOBULIN","code_information":[{"code":"3008013","type":"CDM"},{"code":"300","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.5,"setting":"both","billing_class":"facility"},{"gross_charge":225.75,"setting":"both","billing_class":"professional"}]},{"description":"TISSUE CULTURE","code_information":[{"code":"3008016","type":"CDM"},{"code":"311","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"setting":"both","billing_class":"facility"},{"gross_charge":333.75,"setting":"both","billing_class":"professional"}]},{"description":"CHROM ANALY;AF/CV 15 CELLS","code_information":[{"code":"3008019","type":"CDM"},{"code":"311","type":"RC"},{"code":"88267","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.5,"setting":"both","billing_class":"facility"},{"gross_charge":651.5,"setting":"both","billing_class":"professional"}]},{"description":"TOBRAMYCIN","code_information":[{"code":"3008061","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.5,"setting":"both","billing_class":"facility"},{"gross_charge":139.25,"setting":"both","billing_class":"professional"}]},{"description":"TISSUE PROCESSING","code_information":[{"code":"3008079","type":"CDM"},{"code":"300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":84.25,"setting":"both","billing_class":"professional"}]},{"description":"TOPIRAMATE","code_information":[{"code":"3008086","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.5,"setting":"both","billing_class":"facility"},{"gross_charge":119.25,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL PROTEIN BLOOD","code_information":[{"code":"3008100","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"TOTAL T3","code_information":[{"code":"3008260","type":"CDM"},{"code":"301","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.75,"setting":"both","billing_class":"facility"},{"gross_charge":152.0,"setting":"both","billing_class":"professional"}]},{"description":"TOXOPLASMA AB IGG","code_information":[{"code":"3008282","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":159.25,"setting":"both","billing_class":"professional"}]},{"description":"TOXOPLASMA IGM AB","code_information":[{"code":"3008283","type":"CDM"},{"code":"300","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"facility"},{"gross_charge":232.75,"setting":"both","billing_class":"professional"}]},{"description":"TRANSFERRIN MH","code_information":[{"code":"3008310","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","billing_class":"facility"},{"gross_charge":165.5,"setting":"both","billing_class":"professional"}]},{"description":"TRAVEL ALLOWANCE-HOMEBOUND","code_information":[{"code":"3008312","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.25,"setting":"both","billing_class":"facility"}]},{"description":"TRAVEL ALLOWANCE-HOMEBOUND","code_information":[{"code":"3008312","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":26.5,"setting":"both","billing_class":"professional"}]},{"description":"TRICHINELLA AB","code_information":[{"code":"3008323","type":"CDM"},{"code":"300","type":"RC"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.5,"setting":"both","billing_class":"facility"},{"gross_charge":80.5,"setting":"both","billing_class":"professional"}]},{"description":"TRIGLYCERIDES","code_information":[{"code":"3008359","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.5,"setting":"both","billing_class":"facility"},{"gross_charge":116.75,"setting":"both","billing_class":"professional"}]},{"description":"HYBRIDIZATION IN SITU ADDL","code_information":[{"code":"3008364","type":"CDM"},{"code":"310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.25,"setting":"both","billing_class":"facility"},{"gross_charge":168.5,"setting":"both","billing_class":"professional"}]},{"description":"HYBRIDIZATION IN SITU","code_information":[{"code":"3008365","type":"CDM"},{"code":"310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.75,"setting":"both","billing_class":"facility"},{"gross_charge":374.75,"setting":"both","billing_class":"professional"}]},{"description":"TROPONIN","code_information":[{"code":"3008467","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"setting":"both","billing_class":"facility"},{"gross_charge":188.5,"setting":"both","billing_class":"professional"}]},{"description":"T3 REVERSE","code_information":[{"code":"3008478","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"setting":"both","billing_class":"facility"},{"gross_charge":161.75,"setting":"both","billing_class":"professional"}]},{"description":"UREA NITROGEN  URINE","code_information":[{"code":"3008480","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.75,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE MYCOPLASMA","code_information":[{"code":"3008491","type":"CDM"},{"code":"300","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","billing_class":"professional"}]},{"description":"URIC ACID BLOOD","code_information":[{"code":"3008500","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.75,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"URIC ACID OTHER SOURCE","code_information":[{"code":"3008641","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.5,"setting":"both","billing_class":"facility"},{"gross_charge":24.75,"setting":"both","billing_class":"professional"}]},{"description":"URINALYS AUTOM WO MICRO","code_information":[{"code":"3008650","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.5,"setting":"both","billing_class":"facility"},{"gross_charge":45.25,"setting":"both","billing_class":"professional"}]},{"description":"URINALYSIS/COMPLETE","code_information":[{"code":"3008660","type":"CDM"},{"code":"307","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"URINE PROTEIN","code_information":[{"code":"3008664","type":"CDM"},{"code":"301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.75,"setting":"both","billing_class":"facility"},{"gross_charge":82.0,"setting":"both","billing_class":"professional"}]},{"description":"PROTEIN TOTAL URINE","code_information":[{"code":"3008679","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":69.25,"setting":"both","billing_class":"professional"}]},{"description":"VALPROIC ACID","code_information":[{"code":"3008720","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"setting":"both","billing_class":"facility"},{"gross_charge":110.0,"setting":"both","billing_class":"professional"}]},{"description":"VALPROIC ACID X 2","code_information":[{"code":"3008732","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility"},{"gross_charge":219.25,"setting":"both","billing_class":"professional"}]},{"description":"VANCOMYCIN","code_information":[{"code":"3008760","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.75,"setting":"both","billing_class":"facility"},{"gross_charge":183.0,"setting":"both","billing_class":"professional"}]},{"description":"VMA URINE","code_information":[{"code":"3008780","type":"CDM"},{"code":"301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.25,"setting":"both","billing_class":"facility"},{"gross_charge":44.0,"setting":"both","billing_class":"professional"}]},{"description":"VARICELLA-ZOSTER AB","code_information":[{"code":"3008804","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"setting":"both","billing_class":"facility"},{"gross_charge":264.0,"setting":"both","billing_class":"professional"}]},{"description":"PH VENOUS","code_information":[{"code":"3008807","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.75,"setting":"both","billing_class":"facility"},{"gross_charge":170.5,"setting":"both","billing_class":"professional"}]},{"description":"VASOACTIVE INTESTINAL POLY","code_information":[{"code":"3008819","type":"CDM"},{"code":"300","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"setting":"both","billing_class":"facility"},{"gross_charge":169.0,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN D 1 25 DIHYDROXY","code_information":[{"code":"3008841","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.75,"setting":"both","billing_class":"facility"},{"gross_charge":526.5,"setting":"both","billing_class":"professional"}]},{"description":"VISCOSITY SERUM","code_information":[{"code":"3008866","type":"CDM"},{"code":"300","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"facility"},{"gross_charge":123.0,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN A (RETINOL)","code_information":[{"code":"3008871","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.25,"setting":"both","billing_class":"facility"},{"gross_charge":156.0,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN B1 (THIAMINE)","code_information":[{"code":"3008877","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.75,"setting":"both","billing_class":"facility"},{"gross_charge":164.25,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN B12","code_information":[{"code":"3008880","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"setting":"both","billing_class":"facility"},{"gross_charge":214.25,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN E","code_information":[{"code":"3008883","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN B6","code_information":[{"code":"3008885","type":"CDM"},{"code":"300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.75,"setting":"both","billing_class":"facility"},{"gross_charge":318.5,"setting":"both","billing_class":"professional"}]},{"description":"VON WILLEBRAND ANTIGEN","code_information":[{"code":"3008887","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.25,"setting":"both","billing_class":"facility"},{"gross_charge":144.5,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN K  PLASMA","code_information":[{"code":"3008889","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.25,"setting":"both","billing_class":"facility"},{"gross_charge":69.5,"setting":"both","billing_class":"professional"}]},{"description":"VLDL","code_information":[{"code":"3008890","type":"CDM"},{"code":"300","type":"RC"},{"code":"83719","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.5,"setting":"both","billing_class":"professional"}]},{"description":"VON WILLEBRAN FACTOR MULTI","code_information":[{"code":"3008901","type":"CDM"},{"code":"300","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.25,"setting":"both","billing_class":"facility"},{"gross_charge":147.25,"setting":"both","billing_class":"professional"}]},{"description":"WESTERN EQUINE ENCEPHALITI AB","code_information":[{"code":"3008905","type":"CDM"},{"code":"300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.75,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"WEST NILE VIRUS AB IGG","code_information":[{"code":"3008917","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"facility"},{"gross_charge":73.75,"setting":"both","billing_class":"professional"}]},{"description":"WEST NILE VIRUS AB IGM","code_information":[{"code":"3008918","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","billing_class":"facility"},{"gross_charge":73.75,"setting":"both","billing_class":"professional"}]},{"description":"PROSTOGLANDIN EACH","code_information":[{"code":"3008919","type":"CDM"},{"code":"301","type":"RC"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","billing_class":"facility"},{"gross_charge":123.0,"setting":"both","billing_class":"professional"}]},{"description":"SMEAR  INFECTIOUS WET MOUNT","code_information":[{"code":"3008920","type":"CDM"},{"code":"306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.5,"setting":"both","billing_class":"facility"},{"gross_charge":72.5,"setting":"both","billing_class":"professional"}]},{"description":"CYP2C19 GENE COM VARIANTS","code_information":[{"code":"3008921","type":"CDM"},{"code":"310","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.75,"setting":"both","billing_class":"facility"},{"gross_charge":798.75,"setting":"both","billing_class":"professional"}]},{"description":"CYP2C9 GENE COM VARIANTS","code_information":[{"code":"3008929","type":"CDM"},{"code":"310","type":"RC"},{"code":"81227","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.25,"setting":"both","billing_class":"facility"},{"gross_charge":366.5,"setting":"both","billing_class":"professional"}]},{"description":"INF AGENT NA QUAN","code_information":[{"code":"3008932","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.75,"setting":"both","billing_class":"facility"},{"gross_charge":334.5,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO-FISH X 10","code_information":[{"code":"3008936","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.5,"setting":"both","billing_class":"facility"},{"gross_charge":727.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO-FISH X 6","code_information":[{"code":"3008937","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.5,"setting":"both","billing_class":"facility"},{"gross_charge":436.5,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO-FISH X 2","code_information":[{"code":"3008938","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"setting":"both","billing_class":"facility"},{"gross_charge":146.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO-FISH X 7","code_information":[{"code":"3008939","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.25,"setting":"both","billing_class":"facility"},{"gross_charge":509.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO-FISH X 4","code_information":[{"code":"3008941","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.75,"setting":"both","billing_class":"facility"},{"gross_charge":291.25,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO 10-30CELLS","code_information":[{"code":"3008942","type":"CDM"},{"code":"311","type":"RC"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.75,"setting":"both","billing_class":"facility"},{"gross_charge":94.75,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR CYTO 100-300CELLS X5","code_information":[{"code":"3008943","type":"CDM"},{"code":"311","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.5,"setting":"both","billing_class":"facility"},{"gross_charge":916.5,"setting":"both","billing_class":"professional"}]},{"description":"YERSINIA AB IGA/IGM X2","code_information":[{"code":"3008944","type":"CDM"},{"code":"300","type":"RC"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"ZINC SERUM","code_information":[{"code":"3008963","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.25,"setting":"both","billing_class":"facility"},{"gross_charge":147.25,"setting":"both","billing_class":"professional"}]},{"description":"DRUG SCR ZONISAMIDE","code_information":[{"code":"3008975","type":"CDM"},{"code":"300","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"setting":"both","billing_class":"facility"},{"gross_charge":56.25,"setting":"both","billing_class":"professional"}]},{"description":"BILIRUBIN DIRECT","code_information":[{"code":"3009006","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.25,"setting":"both","billing_class":"facility"},{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"BRUCELLA AB","code_information":[{"code":"3009012","type":"CDM"},{"code":"300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"setting":"both","billing_class":"facility"},{"gross_charge":127.5,"setting":"both","billing_class":"professional"}]},{"description":"TIBC WITHIN PROFILE","code_information":[{"code":"3009067","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"IRON SERUM","code_information":[{"code":"3009068","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"NEUTRALIZATION VIRAL","code_information":[{"code":"3009120","type":"CDM"},{"code":"300","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"facility"},{"gross_charge":46.5,"setting":"both","billing_class":"professional"}]},{"description":"IgG SUBCLASS EACH","code_information":[{"code":"3009176","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"setting":"both","billing_class":"facility"},{"gross_charge":86.25,"setting":"both","billing_class":"professional"}]},{"description":"IA INFECTIOUS AGENT AB X 14","code_information":[{"code":"3009227","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"setting":"both","billing_class":"facility"},{"gross_charge":1073.25,"setting":"both","billing_class":"professional"}]},{"description":"STREP GR B ANTIGEN","code_information":[{"code":"3009232","type":"CDM"},{"code":"300","type":"RC"},{"code":"87802","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.5,"setting":"both","billing_class":"professional"}]},{"description":"FLUORESCENT AB  TITER","code_information":[{"code":"3009235","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.25,"setting":"both","billing_class":"facility"},{"gross_charge":61.5,"setting":"both","billing_class":"professional"}]},{"description":"FUNGUS AB NES","code_information":[{"code":"3009236","type":"CDM"},{"code":"300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.25,"setting":"both","billing_class":"facility"},{"gross_charge":62.5,"setting":"both","billing_class":"professional"}]},{"description":"FUNGUS AB NES X 2","code_information":[{"code":"3009237","type":"CDM"},{"code":"300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.5,"setting":"both","billing_class":"facility"},{"gross_charge":124.5,"setting":"both","billing_class":"professional"}]},{"description":"ALLERGEN SPECIFIC IGE EACH","code_information":[{"code":"3009239","type":"CDM"},{"code":"300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.5,"setting":"both","billing_class":"facility"},{"gross_charge":49.5,"setting":"both","billing_class":"professional"}]},{"description":"RBC AUTOMATED","code_information":[{"code":"3009243","type":"CDM"},{"code":"300","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.25,"setting":"both","billing_class":"facility"},{"gross_charge":25.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONAB X 8","code_information":[{"code":"3009249","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.75,"setting":"both","billing_class":"facility"},{"gross_charge":634.75,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONAB","code_information":[{"code":"3009250","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"facility"},{"gross_charge":120.0,"setting":"both","billing_class":"professional"}]},{"description":"GANGLIOSIDE ANTIBODY PANEL","code_information":[{"code":"3009251","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.75,"setting":"both","billing_class":"facility"},{"gross_charge":479.0,"setting":"both","billing_class":"professional"}]},{"description":"ANDROSTANEDIOL GLUCURONIDE","code_information":[{"code":"3009252","type":"CDM"},{"code":"300","type":"RC"},{"code":"82154","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"setting":"both","billing_class":"facility"},{"gross_charge":72.0,"setting":"both","billing_class":"professional"}]},{"description":"ROCKY MTN FEV IGG","code_information":[{"code":"3009258","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.25,"setting":"both","billing_class":"facility"},{"gross_charge":57.25,"setting":"both","billing_class":"professional"}]},{"description":"TREPONEMA PALLIDUM","code_information":[{"code":"3009262","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"facility"},{"gross_charge":49.25,"setting":"both","billing_class":"professional"}]},{"description":"LIPOPROTEIN BLOOD IN PROFILE","code_information":[{"code":"3009266","type":"CDM"},{"code":"300","type":"RC"},{"code":"83701","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.75,"setting":"both","billing_class":"facility"},{"gross_charge":282.25,"setting":"both","billing_class":"professional"}]},{"description":"PHENOTYPE PREDICTION","code_information":[{"code":"3009272","type":"CDM"},{"code":"300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.75,"setting":"both","billing_class":"facility"},{"gross_charge":397.25,"setting":"both","billing_class":"professional"}]},{"description":"PREKALLIKREIN ASSAY","code_information":[{"code":"3009274","type":"CDM"},{"code":"300","type":"RC"},{"code":"85292","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"HMW KININOGEN ASSAY","code_information":[{"code":"3009275","type":"CDM"},{"code":"300","type":"RC"},{"code":"85293","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.25,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","billing_class":"professional"}]},{"description":"CANDIDA ANTIBODY X 2","code_information":[{"code":"3009276","type":"CDM"},{"code":"300","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"setting":"both","billing_class":"facility"},{"gross_charge":563.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTATIN C","code_information":[{"code":"3009279","type":"CDM"},{"code":"300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"facility"},{"gross_charge":35.0,"setting":"both","billing_class":"professional"}]},{"description":"ALPHA FETOPROTEIN L3","code_information":[{"code":"3009287","type":"CDM"},{"code":"301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"setting":"both","billing_class":"facility"},{"gross_charge":176.75,"setting":"both","billing_class":"professional"}]},{"description":"CHYLOMICRON SCREEN BODY FLUID","code_information":[{"code":"3009292","type":"CDM"},{"code":"301","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"BRCA2 GENE","code_information":[{"code":"3009293","type":"CDM"},{"code":"310","type":"RC"},{"code":"81217","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.5,"setting":"both","billing_class":"facility"},{"gross_charge":249.75,"setting":"both","billing_class":"professional"}]},{"description":"HBA1/HBA2 GENE ALPHA-THALASSEM","code_information":[{"code":"3009294","type":"CDM"},{"code":"310","type":"RC"},{"code":"81257","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"setting":"both","billing_class":"facility"},{"gross_charge":380.25,"setting":"both","billing_class":"professional"}]},{"description":"THYROXINE  TOTAL","code_information":[{"code":"3009500","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","billing_class":"facility"},{"gross_charge":35.25,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN D 25 HYDROXY","code_information":[{"code":"3009550","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"setting":"both","billing_class":"facility"},{"gross_charge":87.0,"setting":"both","billing_class":"professional"}]},{"description":"CALPROTECTIN  FECAL","code_information":[{"code":"3009750","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.0,"setting":"both","billing_class":"professional"}]},{"description":"REDUCING SUBSTANCES FECES","code_information":[{"code":"3009801","type":"CDM"},{"code":"300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.75,"setting":"both","billing_class":"facility"},{"gross_charge":26.0,"setting":"both","billing_class":"professional"}]},{"description":"TRICYCLIC ANTIDEPRESANT SCREEN","code_information":[{"code":"3009802","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"setting":"both","billing_class":"facility"},{"gross_charge":175.0,"setting":"both","billing_class":"professional"}]},{"description":"APOE ALZHIMERS RISK","code_information":[{"code":"3009803","type":"CDM"},{"code":"300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"setting":"both","billing_class":"facility"},{"gross_charge":340.75,"setting":"both","billing_class":"professional"}]},{"description":"MOTPATH PROCEDURE LEVEL 4","code_information":[{"code":"3009804","type":"CDM"},{"code":"310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":221.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LVL 5 SEND OUT","code_information":[{"code":"3009805","type":"CDM"},{"code":"301","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.25,"setting":"both","billing_class":"facility"},{"gross_charge":77.75,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH LVL 6 SEND OUT","code_information":[{"code":"3009806","type":"CDM"},{"code":"300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.5,"setting":"both","billing_class":"facility"},{"gross_charge":221.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLEUCULAR PATH LVL 7 SEND OUT","code_information":[{"code":"3009807","type":"CDM"},{"code":"310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.5,"setting":"both","billing_class":"facility"},{"gross_charge":221.0,"setting":"both","billing_class":"professional"}]},{"description":"MOPATH PROC LVL 8 SENDOUT","code_information":[{"code":"3009808","type":"CDM"},{"code":"310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":221.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATH UNL SEND OUT","code_information":[{"code":"3009809","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"setting":"both","billing_class":"facility"},{"gross_charge":221.0,"setting":"both","billing_class":"professional"}]},{"description":"COBAS HPV RECTAL-SENDOUT","code_information":[{"code":"3009811","type":"CDM"},{"code":"306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.25,"setting":"both","billing_class":"facility"},{"gross_charge":39.75,"setting":"both","billing_class":"professional"}]},{"description":"VOLATILES WHOLD BLOOD-SENDOUT","code_information":[{"code":"3009812","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"setting":"both","billing_class":"facility"},{"gross_charge":6.25,"setting":"both","billing_class":"professional"}]},{"description":"FIBRIN OR COAG SCREEN-SENDOUT","code_information":[{"code":"3009814","type":"CDM"},{"code":"300","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"setting":"both","billing_class":"facility"},{"gross_charge":153.0,"setting":"both","billing_class":"professional"}]},{"description":"ELECTRON MICRO-SENDOUT","code_information":[{"code":"3009815","type":"CDM"},{"code":"310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.5,"setting":"both","billing_class":"facility"},{"gross_charge":1122.0,"setting":"both","billing_class":"professional"}]},{"description":"GLU RANDOM URINE SENDOUT","code_information":[{"code":"3009817","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"setting":"both","billing_class":"facility"},{"gross_charge":199.75,"setting":"both","billing_class":"professional"}]},{"description":"GlUCOTETRA URINE SENDOUT","code_information":[{"code":"3009818","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"setting":"both","billing_class":"facility"},{"gross_charge":199.75,"setting":"both","billing_class":"professional"}]},{"description":"ANTIPSYCHOTIC URINE-SENDOUT","code_information":[{"code":"3009819","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.25,"setting":"both","billing_class":"facility"},{"gross_charge":109.25,"setting":"both","billing_class":"professional"}]},{"description":"ANTI-TIF ANTIBODY-SENDOUT","code_information":[{"code":"3009820","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"ANTI-PL7 ANTIBODY-SENDOUT","code_information":[{"code":"3009822","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.25,"setting":"both","billing_class":"facility"},{"gross_charge":37.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG TST PRSMV CHEM ANLYZR","code_information":[{"code":"3009823","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"setting":"both","billing_class":"facility"},{"gross_charge":194.0,"setting":"both","billing_class":"professional"}]},{"description":"COVID 19 PCR HI TECH-VENDOR","code_information":[{"code":"3009830","type":"CDM"},{"code":"300","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.75,"setting":"both","billing_class":"facility"},{"gross_charge":17.25,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY TROPONIN QUANT-SENDOUT","code_information":[{"code":"3009832","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"setting":"both","billing_class":"facility"},{"gross_charge":21.0,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY OF ESTRONE-SENDOUT","code_information":[{"code":"3009833","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":45.75,"setting":"both","billing_class":"professional"}]},{"description":"DRUG ASSAY LEFLUNOMIDE-SENDOUT","code_information":[{"code":"3009834","type":"CDM"},{"code":"300","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.75,"setting":"both","billing_class":"facility"},{"gross_charge":15.5,"setting":"both","billing_class":"professional"}]},{"description":"ANTI OVERY ANTIBODIES SENDOUT","code_information":[{"code":"3009835","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.5,"setting":"both","billing_class":"facility"},{"gross_charge":84.75,"setting":"both","billing_class":"professional"}]},{"description":"HALOPERIDOL SERUM SENDOUT","code_information":[{"code":"3009836","type":"CDM"},{"code":"300","type":"RC"},{"code":"80173","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"facility"},{"gross_charge":13.5,"setting":"both","billing_class":"professional"}]},{"description":"BP 180 & 230 SERUM SENDOUT","code_information":[{"code":"3009838","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.75,"setting":"both","billing_class":"facility"},{"gross_charge":390.75,"setting":"both","billing_class":"professional"}]},{"description":"FIBRIN DEGRADATION-SENDOUT","code_information":[{"code":"3009839","type":"CDM"},{"code":"305","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"setting":"both","billing_class":"facility"},{"gross_charge":30.25,"setting":"both","billing_class":"professional"}]},{"description":"CLOT FACT XIII FB SCRN-SENDOUT","code_information":[{"code":"3009840","type":"CDM"},{"code":"300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.75,"setting":"both","billing_class":"facility"},{"gross_charge":94.75,"setting":"both","billing_class":"professional"}]},{"description":"SARSCOV CORONAVIRUS AG IA","code_information":[{"code":"3009842","type":"CDM"},{"code":"306","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.5,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":92.75,"setting":"both","modifiers":"QW","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"ANTI FODRIN ANTIBODIES SENDOUT","code_information":[{"code":"3009843","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.75,"setting":"both","billing_class":"facility"},{"gross_charge":132.75,"setting":"both","billing_class":"professional"}]},{"description":"BIRD FANCIER ALLERGEN SENDOUT","code_information":[{"code":"3009844","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"BIRD FANCIER ALLERG SENDOUT","code_information":[{"code":"3009845","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","billing_class":"professional"}]},{"description":"BIRD FANCIER ALLERGEN SENDOUT","code_information":[{"code":"3009846","type":"CDM"},{"code":"300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.25,"setting":"both","billing_class":"facility"}]},{"description":"BIRD FANCIER ALLERGEN SENDOUT","code_information":[{"code":"3009846","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"setting":"both","billing_class":"professional"}]},{"description":"LIPASE BODY FLUID-SENDOUT","code_information":[{"code":"3009848","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"setting":"both","billing_class":"facility"},{"gross_charge":95.0,"setting":"both","billing_class":"professional"}]},{"description":"CEA PANCREATIC CYST-SENDOUT","code_information":[{"code":"3009849","type":"CDM"},{"code":"301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"DESMOGLEIN 1 & 3 SERUM-SENDOUT","code_information":[{"code":"3009850","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"setting":"both","billing_class":"facility"},{"gross_charge":391.0,"setting":"both","billing_class":"professional"}]},{"description":"BCR-ABL","code_information":[{"code":"3009851","type":"CDM"},{"code":"300","type":"RC"},{"code":"0016U","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"setting":"both","billing_class":"facility"},{"gross_charge":211.25,"setting":"both","billing_class":"professional"}]},{"description":"EMA EACH IG CLASS-MAYO-SENDOUT","code_information":[{"code":"3009854","type":"CDM"},{"code":"302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.75,"setting":"both","billing_class":"professional"}]},{"description":"OXIDIZED LDL-SENDOUT","code_information":[{"code":"3009855","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"setting":"both","billing_class":"facility"},{"gross_charge":23.5,"setting":"both","billing_class":"professional"}]},{"description":"COL CHROM QUAL/QUAN-SENDOUT","code_information":[{"code":"3009857","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"VITAMIN D 25 HYDROXY-SENDOUT","code_information":[{"code":"3009858","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.25,"setting":"both","billing_class":"facility"},{"gross_charge":78.25,"setting":"both","billing_class":"professional"}]},{"description":"NMR LDL-P-SENDOUT","code_information":[{"code":"3009859","type":"CDM"},{"code":"300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.25,"setting":"both","billing_class":"facility"},{"gross_charge":82.0,"setting":"both","billing_class":"professional"}]},{"description":"DIURETIC 8 DRUG SCR URINE","code_information":[{"code":"3009861","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.5,"setting":"both","billing_class":"facility"},{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY OF AMYLASE-SENDOUT","code_information":[{"code":"3009862","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.5,"setting":"both","billing_class":"facility"},{"gross_charge":255.75,"setting":"both","billing_class":"professional"}]},{"description":"LYME DISEASE ANTIBODY","code_information":[{"code":"3009863","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"facility"},{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"F2 GENE 20210G >A VAR-SENDOUT","code_information":[{"code":"3009864","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"setting":"both","billing_class":"facility"},{"gross_charge":897.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY QUANT NONAB X 2","code_information":[{"code":"3009866","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"},{"gross_charge":41.25,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOASSAY NONANTIBODY","code_information":[{"code":"3009867","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"facility"},{"gross_charge":120.0,"setting":"both","billing_class":"professional"}]},{"description":"COL CHROMO QUAL/QUAN-SENDOUT","code_information":[{"code":"3009869","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.5,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY AMINO ACID-SENDOUT","code_information":[{"code":"3009870","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.5,"setting":"both","billing_class":"facility"},{"gross_charge":180.75,"setting":"both","billing_class":"professional"}]},{"description":"DHR FLOW CYTOM BLOOD-SENDOUT","code_information":[{"code":"3009875","type":"CDM"},{"code":"300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.5,"setting":"both","billing_class":"facility"},{"gross_charge":340.25,"setting":"both","billing_class":"professional"}]},{"description":"DHR FLOW CYTOMETRY BLD-SENDOUT","code_information":[{"code":"3009876","type":"CDM"},{"code":"300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.5,"setting":"both","billing_class":"facility"},{"gross_charge":340.25,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY THYROGLOBULIN-SENDOUT","code_information":[{"code":"3009879","type":"CDM"},{"code":"301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"setting":"both","billing_class":"facility"},{"gross_charge":149.75,"setting":"both","billing_class":"professional"}]},{"description":"THYROGLOBULIN ANTIBODY-SENDOUT","code_information":[{"code":"3009880","type":"CDM"},{"code":"302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"setting":"both","billing_class":"facility"},{"gross_charge":149.75,"setting":"both","billing_class":"professional"}]},{"description":"ASPERGILLUS AG SERUM-SENDOUT","code_information":[{"code":"3009882","type":"CDM"},{"code":"306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.25,"setting":"both","billing_class":"facility"},{"gross_charge":60.75,"setting":"both","billing_class":"professional"}]},{"description":"CREATININE BODY FLUID-SENDOUT","code_information":[{"code":"3009883","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.5,"setting":"both","billing_class":"facility"},{"gross_charge":61.0,"setting":"both","billing_class":"professional"}]},{"description":"HSV 1 HSV 2","code_information":[{"code":"3009884","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.75,"setting":"both","billing_class":"facility"},{"gross_charge":215.25,"setting":"both","billing_class":"professional"}]},{"description":"DETCT AGNT NOS DNA AMP-SENDOUT","code_information":[{"code":"3009885","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.75,"setting":"both","billing_class":"facility"},{"gross_charge":81.75,"setting":"both","billing_class":"professional"}]},{"description":"ORTHOPOXVIRUS AMP PRB-SENDOUT","code_information":[{"code":"3009886","type":"CDM"},{"code":"306","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.75,"setting":"both","billing_class":"facility"},{"gross_charge":78.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMILUMINESCENT ASSAY-SENDOUT","code_information":[{"code":"3009887","type":"CDM"},{"code":"301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"TESTOSTRON TOTAL LC/MS-SENDOUT","code_information":[{"code":"3009889","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"setting":"both","billing_class":"facility"},{"gross_charge":7.0,"setting":"both","billing_class":"professional"}]},{"description":"HEXO A & TOTAL HEXO LE-SENDOUT","code_information":[{"code":"3009890","type":"CDM"},{"code":"300","type":"RC"},{"code":"83080","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.5,"setting":"both","billing_class":"facility"},{"gross_charge":534.5,"setting":"both","billing_class":"professional"}]},{"description":"ENZYME CELL ACTIVITY-SENDOUT","code_information":[{"code":"3009892","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"setting":"both","billing_class":"facility"},{"gross_charge":313.5,"setting":"both","billing_class":"professional"}]},{"description":"ASSAY OF GLUCOSIDASE-SENDOUT","code_information":[{"code":"3009893","type":"CDM"},{"code":"300","type":"RC"},{"code":"82963","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"setting":"both","billing_class":"facility"},{"gross_charge":313.5,"setting":"both","billing_class":"professional"}]},{"description":"SMEAR COMPLEX STAIN-SENDOUT","code_information":[{"code":"3009895","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.25,"setting":"both","billing_class":"facility"},{"gross_charge":4.5,"setting":"both","billing_class":"professional"}]},{"description":"OVA & PARASITES SMEARS-SENDOUT","code_information":[{"code":"3009896","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.75,"setting":"both","billing_class":"facility"}]},{"description":"GENETIC TEST FOR INHERITED CON","code_information":[{"code":"3009897","type":"CDM"},{"code":"310","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":5292.0,"setting":"both","billing_class":"facility"}]},{"description":"BACTERIAL BLOOD CULTURE-SO","code_information":[{"code":"3050000","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"setting":"both","billing_class":"facility"},{"gross_charge":64.0,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE ANAEROBIC IDENTIFY-SO","code_information":[{"code":"3050001","type":"CDM"},{"code":"306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"setting":"both","billing_class":"facility"},{"gross_charge":79.0,"setting":"both","billing_class":"professional"}]},{"description":"CULTURE AEROBIC IDENTIFY-SO","code_information":[{"code":"3050002","type":"CDM"},{"code":"306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"setting":"both","billing_class":"facility"},{"gross_charge":79.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO RHEUMATOID FACTOR","code_information":[{"code":"3050010","type":"CDM"},{"code":"302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"setting":"both","billing_class":"facility"},{"gross_charge":72.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO HEMOGLOBIN A1C","code_information":[{"code":"3050011","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"setting":"both","billing_class":"facility"},{"gross_charge":32.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO TESTOSTERONE; FREE","code_information":[{"code":"3050012","type":"CDM"},{"code":"301","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"setting":"both","billing_class":"facility"},{"gross_charge":18.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCORP TESTOSTERONE; TOTAL","code_information":[{"code":"3050013","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"setting":"both","billing_class":"facility"},{"gross_charge":18.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO PROTEIN E-PHORESIS SERUM","code_information":[{"code":"3050014","type":"CDM"},{"code":"301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"facility"},{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"LABCO ASSAY OF PROTEIN SERUM","code_information":[{"code":"3050015","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.5,"setting":"both","billing_class":"facility"},{"gross_charge":18.5,"setting":"both","billing_class":"professional"}]},{"description":"LABCO ALPHA-FETOPROTEIN","code_information":[{"code":"3050016","type":"CDM"},{"code":"301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"setting":"both","billing_class":"facility"},{"gross_charge":34.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO ORGANIC ACID SINGLE","code_information":[{"code":"3050017","type":"CDM"},{"code":"301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO ASSAY IGA/IGD/IGG/IGM x3","code_information":[{"code":"3050018","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"},{"gross_charge":30.75,"setting":"both","billing_class":"professional"}]},{"description":"LABCO IMMUNOFIX E-PHORESIS SRM","code_information":[{"code":"3050019","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.25,"setting":"both","billing_class":"facility"},{"gross_charge":10.25,"setting":"both","billing_class":"professional"}]},{"description":"LABCO SYPHILIS DETECTION TEST","code_information":[{"code":"3050020","type":"CDM"},{"code":"302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"setting":"both","billing_class":"facility"},{"gross_charge":31.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO IG LIGHT CHAIN FREE EAx2","code_information":[{"code":"3050021","type":"CDM"},{"code":"301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"setting":"both","billing_class":"facility"},{"gross_charge":57.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO IMMUNOASSAY TMR CA 15-3","code_information":[{"code":"3050022","type":"CDM"},{"code":"302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"setting":"both","billing_class":"facility"},{"gross_charge":33.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO COMPLEMENT ANTIGEN","code_information":[{"code":"3050023","type":"CDM"},{"code":"302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"setting":"both","billing_class":"facility"},{"gross_charge":32.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO BRCA1&2 GENE FULL ANLYS","code_information":[{"code":"3050024","type":"CDM"},{"code":"310","type":"RC"},{"code":"81163","type":"HCPCS"}],"standard_charges":[{"gross_charge":1499.0,"setting":"both","billing_class":"facility"},{"gross_charge":1499.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO BARBITURATES DRUG SCREEN","code_information":[{"code":"3050025","type":"CDM"},{"code":"300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"setting":"both","billing_class":"facility"},{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO QUANTITATIVE ASSAY DRUG","code_information":[{"code":"3050026","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"setting":"both","billing_class":"facility"},{"gross_charge":64.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO TESTOSTERONE BIOVLBL","code_information":[{"code":"3050027","type":"CDM"},{"code":"301","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"setting":"both","billing_class":"facility"},{"gross_charge":68.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO CMV ANTIBODY","code_information":[{"code":"3050028","type":"CDM"},{"code":"302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"setting":"both","billing_class":"facility"},{"gross_charge":43.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO UGT1A1 GENE ANALYSIS","code_information":[{"code":"3050029","type":"CDM"},{"code":"310","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"setting":"both","billing_class":"facility"},{"gross_charge":274.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO CHROMIUM ASSAY","code_information":[{"code":"3050030","type":"CDM"},{"code":"301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.5,"setting":"both","billing_class":"facility"},{"gross_charge":30.5,"setting":"both","billing_class":"professional"}]},{"description":"LABCO HEAVY METAL QUANT EA NES","code_information":[{"code":"3050031","type":"CDM"},{"code":"301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.5,"setting":"both","billing_class":"facility"},{"gross_charge":30.5,"setting":"both","billing_class":"professional"}]},{"description":"LABCO MOPATH PROC LVL 9","code_information":[{"code":"3050032","type":"CDM"},{"code":"300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"setting":"both","billing_class":"facility"},{"gross_charge":1819.0,"setting":"both","billing_class":"professional"}]},{"description":"LABC HLA 1 TYPING 1 ALLELE HR","code_information":[{"code":"3050033","type":"CDM"},{"code":"310","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"setting":"both","billing_class":"facility"},{"gross_charge":180.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO UNLSTD TROFILE MICRO PX","code_information":[{"code":"3050034","type":"CDM"},{"code":"306","type":"RC"},{"code":"87999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1871.0,"setting":"both","billing_class":"facility"},{"gross_charge":1871.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO LINEZOLID LVL QNT ASSAY","code_information":[{"code":"3050035","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"setting":"both","billing_class":"facility"},{"gross_charge":133.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO NATRIURETIC PEPTIDE","code_information":[{"code":"3050036","type":"CDM"},{"code":"301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"},{"gross_charge":74.0,"setting":"both","billing_class":"professional"}]},{"description":"LABCO GLUCAGON, PLASMA","code_information":[{"code":"3050037","type":"CDM"},{"code":"300","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"setting":"both","billing_class":"facility"},{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IG M-PROTEIN QUAL BLD/UR","code_information":[{"code":"3050600","type":"CDM"},{"code":"300","type":"RC"},{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"setting":"both","billing_class":"facility"},{"gross_charge":71.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO ASSAY IGA/IGG/IGM X3","code_information":[{"code":"3050601","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"setting":"both","billing_class":"facility"},{"gross_charge":213.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO DETECT AGENT NOS DNA AMP","code_information":[{"code":"3050602","type":"CDM"},{"code":"306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"setting":"both","billing_class":"facility"},{"gross_charge":734.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOMEG DNA AMP PROBE","code_information":[{"code":"3050603","type":"CDM"},{"code":"306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"setting":"both","billing_class":"facility"},{"gross_charge":517.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO HSV DNA AMP PROBE X2","code_information":[{"code":"3050604","type":"CDM"},{"code":"306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"setting":"both","billing_class":"facility"},{"gross_charge":517.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO PROTEIN WESTERN BLOT TEST","code_information":[{"code":"3050605","type":"CDM"},{"code":"301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"setting":"both","billing_class":"facility"},{"gross_charge":318.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADD-ON","code_information":[{"code":"3050606","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"setting":"both","billing_class":"facility"},{"gross_charge":49.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC 1 MARKER","code_information":[{"code":"3050607","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"setting":"both","billing_class":"facility"},{"gross_charge":56.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO AQAPRN-4 ANTB FLO CYTMTRY","code_information":[{"code":"3050608","type":"CDM"},{"code":"302","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.5,"setting":"both","billing_class":"facility"},{"gross_charge":389.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO MOG-IGG1 ANTB FLO CYTMTRY","code_information":[{"code":"3050609","type":"CDM"},{"code":"302","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.5,"setting":"both","billing_class":"facility"},{"gross_charge":389.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY 9-15 MARKER","code_information":[{"code":"3050610","type":"CDM"},{"code":"300","type":"RC"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"},{"gross_charge":181.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO ISLET CELL ANTIBODY","code_information":[{"code":"3050611","type":"CDM"},{"code":"302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"facility"},{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IMMUNOASSAY QUANT NONABx3","code_information":[{"code":"3050612","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"setting":"both","billing_class":"facility"},{"gross_charge":722.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO TISSUE CULTUR BONE MARROW","code_information":[{"code":"3050613","type":"CDM"},{"code":"310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.5,"setting":"both","billing_class":"facility"},{"gross_charge":324.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTO/MOLECULAR REPORT","code_information":[{"code":"3050614","type":"CDM"},{"code":"310","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.5,"setting":"both","billing_class":"facility"},{"gross_charge":324.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO MALABS AAT CALPRO PNCRTC","code_information":[{"code":"3050615","type":"CDM"},{"code":"300","type":"RC"},{"code":"0430U","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"setting":"both","billing_class":"facility"},{"gross_charge":579.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CHROMOSOME ANALYSIS 20-25","code_information":[{"code":"3050616","type":"CDM"},{"code":"310","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"setting":"both","billing_class":"facility"},{"gross_charge":229.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO RIA NONANTIBODY","code_information":[{"code":"3050617","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLUORESCENT ANTB SCREENx9","code_information":[{"code":"3050618","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"setting":"both","billing_class":"facility"},{"gross_charge":558.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO VOLTAGE-GTD CA CHNL ANTB","code_information":[{"code":"3050619","type":"CDM"},{"code":"300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"setting":"both","billing_class":"facility"},{"gross_charge":63.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO MITOCHONDRIAL ANTIBODY","code_information":[{"code":"3050620","type":"CDM"},{"code":"302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"setting":"both","billing_class":"facility"},{"gross_charge":171.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO ANTINUCLEAR ANA TITER","code_information":[{"code":"3050621","type":"CDM"},{"code":"302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"setting":"both","billing_class":"facility"},{"gross_charge":170.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO ACTIN ANTIBODY EACH","code_information":[{"code":"3050622","type":"CDM"},{"code":"302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"setting":"both","billing_class":"facility"},{"gross_charge":170.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/READ 16 & >","code_information":[{"code":"3050623","type":"CDM"},{"code":"300","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"setting":"both","billing_class":"facility"},{"gross_charge":219.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/READ 2-8","code_information":[{"code":"3050624","type":"CDM"},{"code":"311","type":"RC"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"setting":"both","billing_class":"facility"},{"gross_charge":139.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOW CELL MARKER STUDY","code_information":[{"code":"3050625","type":"CDM"},{"code":"311","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"setting":"both","billing_class":"facility"},{"gross_charge":401.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO COMPRE CONSLTJ RVW REC","code_information":[{"code":"3050626","type":"CDM"},{"code":"310","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"setting":"both","billing_class":"facility"},{"gross_charge":309.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO MICRODISSECTION MANUAL","code_information":[{"code":"3050627","type":"CDM"},{"code":"310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"setting":"both","billing_class":"facility"},{"gross_charge":119.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IMHCHEM/IMCYTCHM 1ST ANTB","code_information":[{"code":"3050628","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"setting":"both","billing_class":"facility"},{"gross_charge":165.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IMHCHEM/IMCYTCHM EA ADD","code_information":[{"code":"3050629","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"setting":"both","billing_class":"facility"},{"gross_charge":165.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS DNA PROBE","code_information":[{"code":"3050630","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.5,"setting":"both","billing_class":"facility"},{"gross_charge":284.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS 100-300","code_information":[{"code":"3050631","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.5,"setting":"both","billing_class":"facility"},{"gross_charge":284.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDON X5","code_information":[{"code":"3050632","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDON X7","code_information":[{"code":"3050633","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"setting":"both","billing_class":"facility"},{"gross_charge":169.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDON X9","code_information":[{"code":"3050634","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"setting":"both","billing_class":"facility"},{"gross_charge":209.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONX11","code_information":[{"code":"3050635","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"setting":"both","billing_class":"facility"},{"gross_charge":249.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONX15","code_information":[{"code":"3050636","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"setting":"both","billing_class":"facility"},{"gross_charge":329.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONX23","code_information":[{"code":"3050637","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"setting":"both","billing_class":"facility"},{"gross_charge":489.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONX18","code_information":[{"code":"3050638","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"setting":"both","billing_class":"facility"},{"gross_charge":389.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONX14","code_information":[{"code":"3050639","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"setting":"both","billing_class":"facility"},{"gross_charge":309.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO-AML,11 GENE, NGS,V","code_information":[{"code":"3050640","type":"CDM"},{"code":"310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"setting":"both","billing_class":"facility"},{"gross_charge":1929.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO JAK2 GENE ANALYSIS","code_information":[{"code":"3050641","type":"CDM"},{"code":"310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"setting":"both","billing_class":"facility"},{"gross_charge":243.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENOMIC NEO ALYS","code_information":[{"code":"3050642","type":"CDM"},{"code":"310","type":"RC"},{"code":"81277","type":"HCPCS"}],"standard_charges":[{"gross_charge":2679.0,"setting":"both","billing_class":"facility"},{"gross_charge":2679.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IDH1 COMMON VARIANTS","code_information":[{"code":"3050643","type":"CDM"},{"code":"310","type":"RC"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.2,"setting":"both","billing_class":"facility"},{"gross_charge":356.2,"setting":"both","billing_class":"professional"}]},{"description":"MAYO IDH2 COMMON VARIANTS","code_information":[{"code":"3050644","type":"CDM"},{"code":"310","type":"RC"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.2,"setting":"both","billing_class":"facility"},{"gross_charge":356.2,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLT3 GENE ANALYSIS (ITD)","code_information":[{"code":"3050645","type":"CDM"},{"code":"310","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.2,"setting":"both","billing_class":"facility"},{"gross_charge":356.2,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLT3 GENE ANALYSIS (TKD)","code_information":[{"code":"3050646","type":"CDM"},{"code":"310","type":"RC"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.2,"setting":"both","billing_class":"facility"},{"gross_charge":356.2,"setting":"both","billing_class":"professional"}]},{"description":"MAYO TP53 GENE TRGT SEQN ALYS","code_information":[{"code":"3050647","type":"CDM"},{"code":"310","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.2,"setting":"both","billing_class":"facility"},{"gross_charge":356.2,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS DNA PROBEx12","code_information":[{"code":"3050648","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.7,"setting":"both","billing_class":"facility"},{"gross_charge":740.7,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS 100-300x6","code_information":[{"code":"3050649","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.8,"setting":"both","billing_class":"facility"},{"gross_charge":369.8,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS DNA PROBEx2","code_information":[{"code":"3050650","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"setting":"both","billing_class":"facility"},{"gross_charge":368.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS DNA PROBEx8","code_information":[{"code":"3050651","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.75,"setting":"both","billing_class":"facility"},{"gross_charge":650.75,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS 100-300x4","code_information":[{"code":"3050652","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.75,"setting":"both","billing_class":"facility"},{"gross_charge":325.75,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYTOMETRY/TC ADDONx21","code_information":[{"code":"3050653","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"setting":"both","billing_class":"facility"},{"gross_charge":449.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CYTOGENETICS 25-99","code_information":[{"code":"3050654","type":"CDM"},{"code":"310","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.5,"setting":"both","billing_class":"facility"},{"gross_charge":977.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYT 1 MARKER-MRD B","code_information":[{"code":"3050655","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.5,"setting":"both","billing_class":"facility"},{"gross_charge":197.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYT ADDON X9-MRD B","code_information":[{"code":"3050656","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"setting":"both","billing_class":"facility"},{"gross_charge":1764.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLOWCYT 9-15 MARKER-MRD B","code_information":[{"code":"3050657","type":"CDM"},{"code":"311","type":"RC"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.5,"setting":"both","billing_class":"facility"},{"gross_charge":197.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO MYELOID NEOPLASM, NGS, V","code_information":[{"code":"3050658","type":"CDM"},{"code":"310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2679.0,"setting":"both","billing_class":"facility"},{"gross_charge":2679.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO ASSAY TSH, SENSITIVE","code_information":[{"code":"3050669","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"setting":"both","billing_class":"facility"},{"gross_charge":55.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO GALACTOKINASE, RBC","code_information":[{"code":"3050670","type":"CDM"},{"code":"300","type":"RC"},{"code":"82759","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"setting":"both","billing_class":"facility"},{"gross_charge":752.0,"setting":"both","billing_class":"professional"}]},{"description":"MAYO FLUORESCNT ANTB SCREENx16","code_information":[{"code":"3050671","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.5,"setting":"both","billing_class":"facility"},{"gross_charge":867.5,"setting":"both","billing_class":"professional"}]},{"description":"MAYO CNS DNA PROBE TYPE 12-25","code_information":[{"code":"3050672","type":"CDM"},{"code":"306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"setting":"both","billing_class":"facility"},{"gross_charge":644.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM 1ST ANTB","code_information":[{"code":"3060400","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMMUNOHISTOCHEM/CMPT","code_information":[{"code":"3060401","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"setting":"both","billing_class":"facility"},{"gross_charge":156.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADD","code_information":[{"code":"3060402","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"setting":"both","billing_class":"facility"},{"gross_charge":96.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG M/PHMTRC ISH QUANT/SEMIQ","code_information":[{"code":"3060403","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"setting":"both","billing_class":"facility"},{"gross_charge":350.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMMUNOHISTOCHEM/MANL","code_information":[{"code":"3060404","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"setting":"both","billing_class":"facility"},{"gross_charge":109.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG MICROSATELLITE INSTABILTY","code_information":[{"code":"3060405","type":"CDM"},{"code":"310","type":"RC"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"setting":"both","billing_class":"facility"},{"gross_charge":667.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG SPECIAL STAINS GROUP 1","code_information":[{"code":"3060406","type":"CDM"},{"code":"312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"setting":"both","billing_class":"facility"},{"gross_charge":137.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX2","code_information":[{"code":"3060407","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"setting":"both","billing_class":"facility"},{"gross_charge":163.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX3","code_information":[{"code":"3060408","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"facility"},{"gross_charge":230.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX4","code_information":[{"code":"3060409","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"setting":"both","billing_class":"facility"},{"gross_charge":297.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX5","code_information":[{"code":"3060410","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"setting":"both","billing_class":"facility"},{"gross_charge":364.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX6","code_information":[{"code":"3060411","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"setting":"both","billing_class":"facility"},{"gross_charge":431.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX7","code_information":[{"code":"3060412","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"setting":"both","billing_class":"facility"},{"gross_charge":498.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX8","code_information":[{"code":"3060413","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"setting":"both","billing_class":"facility"},{"gross_charge":565.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EA ADDX9","code_information":[{"code":"3060414","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"setting":"both","billing_class":"facility"},{"gross_charge":632.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG IMHCHEM/IMCYTCHM EACH X10","code_information":[{"code":"3060415","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"setting":"both","billing_class":"facility"},{"gross_charge":699.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMHCHEM/MANL X2","code_information":[{"code":"3060416","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"setting":"both","billing_class":"facility"},{"gross_charge":189.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMHCHEM/MANL X3","code_information":[{"code":"3060417","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"setting":"both","billing_class":"facility"},{"gross_charge":269.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMHCHEM/CMPT X2","code_information":[{"code":"3060418","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"setting":"both","billing_class":"facility"},{"gross_charge":283.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMHCHEM/CMPT X3","code_information":[{"code":"3060419","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"setting":"both","billing_class":"facility"},{"gross_charge":410.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG TMR IMHCHEM/CMPT X4","code_information":[{"code":"3060420","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"setting":"both","billing_class":"facility"},{"gross_charge":537.0,"setting":"both","billing_class":"professional"}]},{"description":"NEOG M/PHMTRC ISHQUANT/SEMIQ","code_information":[{"code":"3060421","type":"CDM"},{"code":"310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"setting":"both","billing_class":"facility"},{"gross_charge":378.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB IMHCHEM/IMCYTCHM EA ANTB","code_information":[{"code":"3060900","type":"CDM"},{"code":"310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"setting":"both","billing_class":"facility"},{"gross_charge":104.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB IMHCHEM/IMCYTCHM 1ST ANTB","code_information":[{"code":"3060901","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"setting":"both","billing_class":"facility"},{"gross_charge":104.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB IMHCHEM/IMCYTCHM EA ADD","code_information":[{"code":"3060902","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":89.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB CNSLT&RPRT SLD PREP ELSWR","code_information":[{"code":"3060903","type":"CDM"},{"code":"310","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"setting":"both","billing_class":"facility"},{"gross_charge":229.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB COMPRE CONSLTJ RVW REC","code_information":[{"code":"3060904","type":"CDM"},{"code":"310","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility"},{"gross_charge":304.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB TISSUE EXAM BY PATHOLOGST","code_information":[{"code":"3060905","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"setting":"both","billing_class":"facility"},{"gross_charge":129.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB HISTOCHEMICAL STAIN ADDON","code_information":[{"code":"3060906","type":"CDM"},{"code":"312","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"setting":"both","billing_class":"facility"},{"gross_charge":79.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB ENZYME HISTOCHEMISTRY","code_information":[{"code":"3060907","type":"CDM"},{"code":"312","type":"RC"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"setting":"both","billing_class":"facility"},{"gross_charge":79.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB SPECIAL STAINS GROUP 1","code_information":[{"code":"3060908","type":"CDM"},{"code":"312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"setting":"both","billing_class":"facility"},{"gross_charge":115.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB SPECIAL STAINS GROUP 2","code_information":[{"code":"3060909","type":"CDM"},{"code":"312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"setting":"both","billing_class":"facility"},{"gross_charge":97.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB INSITU HYBRDIZATION(FISH)","code_information":[{"code":"3060910","type":"CDM"},{"code":"310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"setting":"both","billing_class":"facility"},{"gross_charge":209.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB CNSLT&RPRT MATRL PREP SLD","code_information":[{"code":"3060911","type":"CDM"},{"code":"312","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"setting":"both","billing_class":"facility"},{"gross_charge":109.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB INSITU HYBRIDIZATION-FISH","code_information":[{"code":"3060912","type":"CDM"},{"code":"310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"setting":"both","billing_class":"facility"},{"gross_charge":89.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB M/PHMTRC REARANGE FISH","code_information":[{"code":"3060913","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"setting":"both","billing_class":"facility"},{"gross_charge":496.0,"setting":"both","billing_class":"professional"}]},{"description":"MLAB M/PHMTRC TRANSLOCATN FISH","code_information":[{"code":"3060914","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"setting":"both","billing_class":"facility"},{"gross_charge":490.0,"setting":"both","billing_class":"professional"}]},{"description":"TPMT GENE ANALYSIS","code_information":[{"code":"3081335","type":"CDM"},{"code":"310","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"setting":"both","billing_class":"facility"},{"gross_charge":503.0,"setting":"both","billing_class":"professional"}]},{"description":"INFORMASEQ FETAL CHROM ANEUPL","code_information":[{"code":"3081420","type":"CDM"},{"code":"300","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.25,"setting":"both","billing_class":"facility"},{"gross_charge":1278.5,"setting":"both","billing_class":"professional"}]},{"description":"T CELLS ABSOLUTE CD4 COUNT","code_information":[{"code":"3086361","type":"CDM"},{"code":"302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.5,"setting":"both","billing_class":"facility"},{"gross_charge":97.75,"setting":"both","billing_class":"professional"}]},{"description":"CANDIDA NA AMPLIFIED PROBE","code_information":[{"code":"3087481","type":"CDM"},{"code":"306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.5,"setting":"both","billing_class":"facility"},{"gross_charge":128.0,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNO HISTO AB","code_information":[{"code":"3088344","type":"CDM"},{"code":"310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.75,"setting":"both","billing_class":"facility"},{"gross_charge":339.75,"setting":"both","billing_class":"professional"}]},{"description":"INSITU HYBRIDIZATION AUTO","code_information":[{"code":"3100101","type":"CDM"},{"code":"310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"setting":"both","billing_class":"facility"},{"gross_charge":311.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTP URINE 3-5 PROBES EA SPEC","code_information":[{"code":"3100102","type":"CDM"},{"code":"310","type":"RC"},{"code":"88121","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"setting":"both","billing_class":"facility"},{"gross_charge":685.0,"setting":"both","billing_class":"professional"}]},{"description":"ONCOLOGY BREAST MRNA","code_information":[{"code":"3100103","type":"CDM"},{"code":"310","type":"RC"},{"code":"81519","type":"HCPCS"}],"standard_charges":[{"gross_charge":6110.0,"setting":"both","billing_class":"facility"},{"gross_charge":5383.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE FOR DECAL","code_information":[{"code":"3100300","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"setting":"both","billing_class":"facility"},{"gross_charge":168.75,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY PROSTATE 10-20 SPECIMEN","code_information":[{"code":"3100356","type":"CDM"},{"code":"310","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.5,"setting":"both","billing_class":"facility"},{"gross_charge":865.25,"setting":"both","billing_class":"professional"}]},{"description":"BONE MARROW SMEAR INTER","code_information":[{"code":"3100362","type":"CDM"},{"code":"310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.5,"setting":"both","billing_class":"facility"},{"gross_charge":720.0,"setting":"both","billing_class":"professional"}]},{"description":"BONE MARROW BX","code_information":[{"code":"3100380","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.5,"setting":"both","billing_class":"facility"},{"gross_charge":1958.75,"setting":"both","billing_class":"professional"}]},{"description":"ENZYME HISOCHEMISTRY","code_information":[{"code":"3100406","type":"CDM"},{"code":"310","type":"RC"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.5,"setting":"both","billing_class":"facility"},{"gross_charge":720.0,"setting":"both","billing_class":"professional"}]},{"description":"HISTOCHEMICAL STAIN ADD'L","code_information":[{"code":"3100407","type":"CDM"},{"code":"310","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.75,"setting":"both","billing_class":"facility"},{"gross_charge":92.25,"setting":"both","billing_class":"professional"}]},{"description":"CP SMEAR NON-GYN SC&INT","code_information":[{"code":"3100555","type":"CDM"},{"code":"310","type":"RC"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.25,"setting":"both","billing_class":"facility"},{"gross_charge":108.25,"setting":"both","billing_class":"professional"}]},{"description":"CP SMEAR NON-GYN PREP S & INT","code_information":[{"code":"3100556","type":"CDM"},{"code":"310","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.75,"setting":"both","billing_class":"facility"},{"gross_charge":257.75,"setting":"both","billing_class":"professional"}]},{"description":"FINE NEEDLE ASPIRATE EVAL","code_information":[{"code":"3100560","type":"CDM"},{"code":"310","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.25,"setting":"both","billing_class":"facility"},{"gross_charge":278.25,"setting":"both","billing_class":"professional"}]},{"description":"FINE NEEDLE ASPIRATE-INTER & R","code_information":[{"code":"3100562","type":"CDM"},{"code":"310","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.25,"setting":"both","billing_class":"facility"},{"gross_charge":295.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE BREAST LESION UND R","code_information":[{"code":"3100567","type":"CDM"},{"code":"361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.25,"setting":"both","billing_class":"facility"},{"gross_charge":749.75,"setting":"both","billing_class":"professional"}]},{"description":"CYTOLOGY SMEAR TP ROUTINE","code_information":[{"code":"3100630","type":"CDM"},{"code":"311","type":"RC"},{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.5,"setting":"both","billing_class":"facility"},{"gross_charge":176.25,"setting":"both","billing_class":"professional"}]},{"description":"CYTOLOGY SMEAR TP DIAG","code_information":[{"code":"3100631","type":"CDM"},{"code":"310","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"setting":"both","billing_class":"facility"},{"gross_charge":166.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTOPATH SMEAR SCREENING","code_information":[{"code":"3100661","type":"CDM"},{"code":"310","type":"RC"},{"code":"88147","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.75,"setting":"both","billing_class":"facility"},{"gross_charge":51.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTOPAH CERVICAL/VAGINAL","code_information":[{"code":"3100750","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"setting":"both","billing_class":"facility"},{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"THIN PREP IMAGING SCREEN ROUTI","code_information":[{"code":"3100752","type":"CDM"},{"code":"311","type":"RC"},{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.25,"setting":"both","billing_class":"facility"},{"gross_charge":265.25,"setting":"both","billing_class":"professional"}]},{"description":"FLOW CYTOMETRY FIRST MARK","code_information":[{"code":"3100850","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"setting":"both","billing_class":"facility"},{"gross_charge":340.0,"setting":"both","billing_class":"professional"}]},{"description":"FLOW CYTOMETRY ADD'L MARKER","code_information":[{"code":"3100855","type":"CDM"},{"code":"310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.75,"setting":"both","billing_class":"facility"},{"gross_charge":74.25,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOCYTOCHEMISTY AB","code_information":[{"code":"3100865","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.5,"setting":"both","billing_class":"facility"},{"gross_charge":539.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNOPEROXIDASE ADDL","code_information":[{"code":"3100866","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.5,"setting":"both","billing_class":"facility"},{"gross_charge":104.25,"setting":"both","billing_class":"professional"}]},{"description":"FROZEN SECTION - EACH ADDITION","code_information":[{"code":"3100900","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.25,"setting":"both","billing_class":"facility"},{"gross_charge":158.5,"setting":"both","billing_class":"professional"}]},{"description":"FROZEN SECTION SINGLE","code_information":[{"code":"3100950","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.25,"setting":"both","billing_class":"facility"},{"gross_charge":305.75,"setting":"both","billing_class":"professional"}]},{"description":"IRON TISSUE","code_information":[{"code":"3101040","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL I SURG PATH","code_information":[{"code":"3101100","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"setting":"both","billing_class":"facility"},{"gross_charge":99.25,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL I SURG PATH-ADDITIONAL","code_information":[{"code":"3101101","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.25,"setting":"both","billing_class":"professional"},{"gross_charge":113.0,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"LEVEL II SURG PATH","code_information":[{"code":"3101110","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.5,"setting":"both","billing_class":"facility"},{"gross_charge":409.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL II SURG PATH  ADDL","code_information":[{"code":"3101111","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"setting":"both","billing_class":"professional"},{"gross_charge":464.5,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"LEVEL III SURG PATH","code_information":[{"code":"3101120","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"},{"gross_charge":428.5,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL III SURG PATH ADDL","code_information":[{"code":"3101121","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.5,"setting":"both","billing_class":"professional"},{"gross_charge":486.5,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"LEVEL IV SURG PATH","code_information":[{"code":"3101130","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.25,"setting":"both","billing_class":"facility"},{"gross_charge":430.75,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL IV SURG PATH ADDL","code_information":[{"code":"3101131","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.75,"setting":"both","billing_class":"professional"},{"gross_charge":489.25,"setting":"both","modifiers":"XS","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier XS: Separate structure, a service that is distinct because it was performed on a separate organ/structure"}]},{"description":"LEVEL V SURG PATH","code_information":[{"code":"3101140","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.75,"setting":"both","billing_class":"facility"},{"gross_charge":470.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL V SURG PATH ADDL","code_information":[{"code":"3101141","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"setting":"both","billing_class":"professional"},{"gross_charge":533.75,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"LEVEL VI SURG PATH","code_information":[{"code":"3101150","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.5,"setting":"both","billing_class":"facility"},{"gross_charge":720.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL VI SURG ADDL","code_information":[{"code":"3101151","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"setting":"both","billing_class":"professional"},{"gross_charge":817.5,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"O.R. REVIEW CASE","code_information":[{"code":"3101200","type":"CDM"},{"code":"310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.75,"setting":"both","billing_class":"facility"},{"gross_charge":254.25,"setting":"both","billing_class":"professional"}]},{"description":"EGFR GENE COM VARIANTS","code_information":[{"code":"3101235","type":"CDM"},{"code":"310","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.75,"setting":"both","billing_class":"facility"},{"gross_charge":604.0,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED CHEMISTRY TEST","code_information":[{"code":"3101329","type":"CDM"},{"code":"300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.5,"setting":"both","billing_class":"facility"},{"gross_charge":69.75,"setting":"both","billing_class":"professional"}]},{"description":"INSITU HYBRIDIZATION MANUAL","code_information":[{"code":"3101331","type":"CDM"},{"code":"310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.25,"setting":"both","billing_class":"facility"},{"gross_charge":356.0,"setting":"both","billing_class":"professional"}]},{"description":"OUTSIDE REVIEW CASES","code_information":[{"code":"3101379","type":"CDM"},{"code":"310","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","billing_class":"facility"},{"gross_charge":165.5,"setting":"both","billing_class":"professional"}]},{"description":"PATH LAB CONSULT SEND OUT","code_information":[{"code":"3101382","type":"CDM"},{"code":"310","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.25,"setting":"both","billing_class":"facility"},{"gross_charge":143.0,"setting":"both","billing_class":"professional"}]},{"description":"SPECIAL STAIN I","code_information":[{"code":"3101410","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"},{"gross_charge":194.25,"setting":"both","billing_class":"professional"}]},{"description":"SPECIAL STAIN II","code_information":[{"code":"3101420","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.5,"setting":"both","billing_class":"facility"},{"gross_charge":234.75,"setting":"both","billing_class":"professional"}]},{"description":"ATN1 GENE DETC ABNOR-SENDOUT","code_information":[{"code":"3101422","type":"CDM"},{"code":"310","type":"RC"},{"code":"81177","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN1 GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101423","type":"CDM"},{"code":"310","type":"RC"},{"code":"81178","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN2 GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101424","type":"CDM"},{"code":"310","type":"RC"},{"code":"81179","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN3 GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101425","type":"CDM"},{"code":"310","type":"RC"},{"code":"81180","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN7 GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101426","type":"CDM"},{"code":"310","type":"RC"},{"code":"81181","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN8OS GEN DETC ABNOR SENDOUT","code_information":[{"code":"3101427","type":"CDM"},{"code":"310","type":"RC"},{"code":"81182","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"ATXN10 GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101428","type":"CDM"},{"code":"310","type":"RC"},{"code":"81183","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"CACNA1A GEN DETC ABNOR SENDOUT","code_information":[{"code":"3101429","type":"CDM"},{"code":"310","type":"RC"},{"code":"81184","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"PPP2R2B GEN DETC ABNOR SENDOUT","code_information":[{"code":"3101430","type":"CDM"},{"code":"310","type":"RC"},{"code":"81343","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"TBP GENE DETC ABNOR SENDOUT","code_information":[{"code":"3101431","type":"CDM"},{"code":"310","type":"RC"},{"code":"81344","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.0,"setting":"both","billing_class":"professional"}]},{"description":"MOLECULAR PATHOLOGY SENDOUT","code_information":[{"code":"3101432","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.5,"setting":"both","billing_class":"facility"},{"gross_charge":83.25,"setting":"both","billing_class":"professional"}]},{"description":"HPRT1 GENE ANALYSIS-SENDOUT","code_information":[{"code":"3101433","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"setting":"both","billing_class":"facility"},{"gross_charge":678.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTOPATH FL NONGYN SMEARS","code_information":[{"code":"3101434","type":"CDM"},{"code":"311","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"setting":"both","billing_class":"facility"},{"gross_charge":77.5,"setting":"both","billing_class":"professional"}]},{"description":"CYTOPATH CONCENTRATE TECH","code_information":[{"code":"3101435","type":"CDM"},{"code":"311","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.5,"setting":"both","billing_class":"facility"},{"gross_charge":79.5,"setting":"both","billing_class":"professional"}]},{"description":"UNLISTED CHEM-SENDOUT","code_information":[{"code":"3101436","type":"CDM"},{"code":"310","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.75,"setting":"both","billing_class":"facility"},{"gross_charge":386.5,"setting":"both","billing_class":"professional"}]},{"description":"IMMUNO GENE CSF-SENDOUT","code_information":[{"code":"3101437","type":"CDM"},{"code":"310","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.25,"setting":"both","billing_class":"facility"},{"gross_charge":566.75,"setting":"both","billing_class":"professional"}]},{"description":"IMM GENE REARANGE CSF-SENDOUT","code_information":[{"code":"3101438","type":"CDM"},{"code":"310","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.25,"setting":"both","billing_class":"facility"},{"gross_charge":566.75,"setting":"both","billing_class":"professional"}]},{"description":"TMAO-SENDOUT","code_information":[{"code":"3101440","type":"CDM"},{"code":"310","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.25,"setting":"both","billing_class":"facility"},{"gross_charge":46.0,"setting":"both","billing_class":"professional"}]},{"description":"VECTRA(R) DA DESEASE-SENDOUT","code_information":[{"code":"3101441","type":"CDM"},{"code":"310","type":"RC"},{"code":"81490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.25,"setting":"both","billing_class":"facility"},{"gross_charge":1009.0,"setting":"both","billing_class":"professional"}]},{"description":"ABDOMEN 1 VIEW","code_information":[{"code":"3200010","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"setting":"both","billing_class":"facility"},{"gross_charge":58.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ABDOMEN-FLAT AND UPRIGHT","code_information":[{"code":"3200040","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.75,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ABDOMEN 3 OR MORE VIEW","code_information":[{"code":"3200060","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.75,"setting":"both","billing_class":"facility"},{"gross_charge":72.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ABDOMEN COMPLETE ACUTE","code_information":[{"code":"3200095","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.5,"setting":"both","billing_class":"facility"},{"gross_charge":82.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ACROMIOCLAVICULAR JOINTS","code_information":[{"code":"3200100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.25,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ANKLE 2 VIEW LT","code_information":[{"code":"3200116","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ANKLE 2 VIEW RT","code_information":[{"code":"3200117","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ANKLE LT","code_information":[{"code":"3200150","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ANKLE RT","code_information":[{"code":"3200151","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM ELBOW LT","code_information":[{"code":"3200210","type":"CDM"},{"code":"322","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM ELBOW LT","code_information":[{"code":"3200210","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM ELBOW RT","code_information":[{"code":"3200220","type":"CDM"},{"code":"322","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM ELBOW RT","code_information":[{"code":"3200220","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-HIP LT","code_information":[{"code":"3200240","type":"CDM"},{"code":"322","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM-HIP LT","code_information":[{"code":"3200240","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1227.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-HIP RT","code_information":[{"code":"3200250","type":"CDM"},{"code":"322","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM-HIP RT","code_information":[{"code":"3200250","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1227.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-KNEE LT","code_information":[{"code":"3200270","type":"CDM"},{"code":"322","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM-KNEE LT","code_information":[{"code":"3200270","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":996.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-KNEE RT","code_information":[{"code":"3200280","type":"CDM"},{"code":"322","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM-KNEE RT","code_information":[{"code":"3200280","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":996.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-ANKLE LT","code_information":[{"code":"3200290","type":"CDM"},{"code":"322","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM-ANKLE LT","code_information":[{"code":"3200290","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-ANKLE RT","code_information":[{"code":"3200300","type":"CDM"},{"code":"322","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM-ANKLE RT","code_information":[{"code":"3200300","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-SHOULDER LT","code_information":[{"code":"3200320","type":"CDM"},{"code":"322","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2323.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM-SHOULDER LT","code_information":[{"code":"3200320","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1652.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-SHOULDER RT","code_information":[{"code":"3200330","type":"CDM"},{"code":"322","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2323.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM-SHOULDER RT","code_information":[{"code":"3200330","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1652.0,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-WRIST LT","code_information":[{"code":"3200350","type":"CDM"},{"code":"322","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ARTHROGRAM-WRIST LT","code_information":[{"code":"3200350","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1112.75,"setting":"both","billing_class":"professional"}]},{"description":"ARTHROGRAM-WRIST RT","code_information":[{"code":"3200360","type":"CDM"},{"code":"322","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ARTHROGRAM-WRIST RT","code_information":[{"code":"3200360","type":"CDM"},{"code":"322","type":"RC"}],"standard_charges":[{"gross_charge":1112.75,"setting":"both","billing_class":"professional"}]},{"description":"BARIUM ENEMA W KUB","code_information":[{"code":"3200371","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.75,"setting":"both","billing_class":"facility"},{"gross_charge":957.75,"setting":"both","billing_class":"professional"}]},{"description":"BARIUM ENEMA AIR CONT W KUB","code_information":[{"code":"3200380","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2149.5,"setting":"both","billing_class":"facility"},{"gross_charge":1528.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE AGE STUDIES","code_information":[{"code":"3200400","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE AGE STUDIES","code_information":[{"code":"3200400","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":617.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE LENGTH STUDY","code_information":[{"code":"3200410","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE LENGTH STUDY","code_information":[{"code":"3200410","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":617.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE SURVEY INFANT","code_information":[{"code":"3200412","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY INFANT","code_information":[{"code":"3200412","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1124.25,"setting":"both","billing_class":"professional"}]},{"description":"BONE SURVEY ADULT","code_information":[{"code":"3200415","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2446.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY ADULT","code_information":[{"code":"3200415","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1739.75,"setting":"both","billing_class":"professional"}]},{"description":"ESOPHOGRAM INCL CHST XRAY","code_information":[{"code":"3200470","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.5,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHOGRAM INCL CHST XRAY","code_information":[{"code":"3200470","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":554.5,"setting":"both","billing_class":"professional"}]},{"description":"CHOLECYSTOGRAM - GB","code_information":[{"code":"3200500","type":"CDM"},{"code":"320","type":"RC"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.25,"setting":"both","billing_class":"facility"}]},{"description":"CHOLECYSTOGRAM - GB","code_information":[{"code":"3200500","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":543.25,"setting":"both","billing_class":"professional"}]},{"description":"CHOLANGIOGRAM - OPERATIVE","code_information":[{"code":"3200510","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.75,"setting":"both","billing_class":"facility"}]},{"description":"CHOLANGIOGRAM - OPERATIVE","code_information":[{"code":"3200510","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1061.5,"setting":"both","billing_class":"professional"}]},{"description":"T-TUBE CHOLANGIOGRAM","code_information":[{"code":"3200520","type":"CDM"},{"code":"320","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.5,"setting":"both","billing_class":"facility"}]},{"description":"T-TUBE CHOLANGIOGRAM","code_information":[{"code":"3200520","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":3659.75,"setting":"both","billing_class":"professional"}]},{"description":"CLAVICLE LT","code_information":[{"code":"3200560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CLAVICLE RT","code_information":[{"code":"3200570","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"3200579","type":"CDM"},{"code":"361","type":"RC"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"setting":"both","billing_class":"facility"}]},{"description":"SPINE CERVICAL OBL","code_information":[{"code":"3200600","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.75,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"NECK SPINE 2 OR 3 VIEWS","code_information":[{"code":"3200610","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.5,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"NECK/SPINE 6 OR MORE VIEWS","code_information":[{"code":"3200630","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"setting":"both","billing_class":"facility"},{"gross_charge":118.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHEST 2 VIEW","code_information":[{"code":"3200645","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"setting":"both","billing_class":"facility"},{"gross_charge":64.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SPINE 2 OR 3 VIEW","code_information":[{"code":"3200648","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.0,"setting":"both","billing_class":"facility"},{"gross_charge":134.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHEST 1 VIEW","code_information":[{"code":"3200660","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.5,"setting":"both","billing_class":"facility"},{"gross_charge":50.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHEST 3 VIEWS","code_information":[{"code":"3200680","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.75,"setting":"both","billing_class":"facility"},{"gross_charge":72.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHEST 4 OR MORE VIEWS","code_information":[{"code":"3200710","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.5,"setting":"both","billing_class":"facility"},{"gross_charge":77.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"CHOLANGIOGRAMD SET FILMS","code_information":[{"code":"3200725","type":"CDM"},{"code":"320","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.25,"setting":"both","billing_class":"facility"}]},{"description":"CHOLANGIOGRAMD SET FILMS","code_information":[{"code":"3200725","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":585.75,"setting":"both","billing_class":"professional"}]},{"description":"CYSTOGRAPHY","code_information":[{"code":"3200730","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.25,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOGRAPHY","code_information":[{"code":"3200730","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":854.75,"setting":"both","billing_class":"professional"}]},{"description":"THORACIC SPINE 3 VIEW","code_information":[{"code":"3200800","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1109.25,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY THORAC SPINE 4 VIEWS","code_information":[{"code":"3200801","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.25,"setting":"both","billing_class":"facility"},{"gross_charge":79.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ELBOW 2 VIEW LT","code_information":[{"code":"3200806","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ELBOW 2 VIEW RT","code_information":[{"code":"3200807","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ELBOW 3 LT","code_information":[{"code":"3200830","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":62.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ELBOW 3 RT","code_information":[{"code":"3200831","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":62.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"DILATE OF STRICTURE/OBSTRUCT","code_information":[{"code":"3200845","type":"CDM"},{"code":"329","type":"RC"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.5,"setting":"both","billing_class":"facility"}]},{"description":"DILATE OF STRICTURE/OBSTRUCT","code_information":[{"code":"3200845","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":318.25,"setting":"both","billing_class":"professional"}]},{"description":"ENTEROCLYSIS SB W KUB","code_information":[{"code":"3200853","type":"CDM"},{"code":"320","type":"RC"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":2469.75,"setting":"both","billing_class":"facility"}]},{"description":"ENTEROCLYSIS SB W KUB","code_information":[{"code":"3200853","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1756.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOSCOPIC CATH BIL/PANC DUCT","code_information":[{"code":"3200856","type":"CDM"},{"code":"320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDOSCOPIC CATH BIL/PANC DUCT","code_information":[{"code":"3200856","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":202.25,"setting":"both","billing_class":"professional"}]},{"description":"ENDOSCOPIC CATH BIL DUCT","code_information":[{"code":"3200857","type":"CDM"},{"code":"320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.25,"setting":"both","billing_class":"facility"}]},{"description":"EXTREMITY UPPER INFANT RT","code_information":[{"code":"3200882","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"EXTREMITY UPPER INFANT LT","code_information":[{"code":"3200883","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":51.0,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"EXTREMITY LOWER INFANT LT","code_information":[{"code":"3200884","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"EXTREMITY LOWER INFANT RT","code_information":[{"code":"3200885","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"EYE FB EXAM, MRI CLEARANCE","code_information":[{"code":"3200887","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.5,"setting":"both","billing_class":"facility"}]},{"description":"EYE FB EXAM, MRI CLEARANCE","code_information":[{"code":"3200887","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":436.0,"setting":"both","billing_class":"professional"}]},{"description":"FACIAL BONES COMPLETE","code_information":[{"code":"3200890","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.25,"setting":"both","billing_class":"facility"},{"gross_charge":91.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"FACIAL BONES LIMITED","code_information":[{"code":"3200893","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.75,"setting":"both","billing_class":"facility"},{"gross_charge":61.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"FEMUR LT 2/> VIEWS","code_information":[{"code":"3200941","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":67.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FEMUR RT 2/> VIEWS","code_information":[{"code":"3200942","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":67.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FEMUR LT 1 VIEW","code_information":[{"code":"3200943","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FEMUR RT 1 VIEW","code_information":[{"code":"3200944","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FISTULAGRAM","code_information":[{"code":"3201010","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1623.0,"setting":"both","billing_class":"facility"}]},{"description":"FISTULAGRAM","code_information":[{"code":"3201010","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1153.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUORO FOR NEEDLE PLCMT","code_information":[{"code":"3201069","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROSCOPY UP TO 1 HOUR","code_information":[{"code":"3201070","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.75,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROSCOPY UP TO 1 HOUR","code_information":[{"code":"3201070","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"setting":"both","billing_class":"professional"}]},{"description":"FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"3201074","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"3201074","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":177.5,"setting":"both","billing_class":"professional"}]},{"description":"FLUOROGUIDE FOR VEIN DEVICE","code_information":[{"code":"3201076","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.25,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROGUIDE FOR VEIN DEVICE","code_information":[{"code":"3201076","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1025.25,"setting":"both","billing_class":"professional"}]},{"description":"FOREARM LT","code_information":[{"code":"3201091","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOREARM RT","code_information":[{"code":"3201092","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT 2 VIEW LT","code_information":[{"code":"3201111","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":54.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT 2 VIEW RT","code_information":[{"code":"3201112","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":54.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT LT","code_information":[{"code":"3201131","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":66.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT RT","code_information":[{"code":"3201132","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":66.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) LT","code_information":[{"code":"3201147","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":55.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) RT","code_information":[{"code":"3201148","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":55.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT DIGITS RT","code_information":[{"code":"3201151","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT DIGITS LT","code_information":[{"code":"3201152","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND 2 VIEW LT","code_information":[{"code":"3201196","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":60.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND 2 VIEW RT","code_information":[{"code":"3201197","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":60.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND LT","code_information":[{"code":"3201260","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND RT","code_information":[{"code":"3201261","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND-DIGITS RT","code_information":[{"code":"3201281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":71.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND-DIGITS LT","code_information":[{"code":"3201282","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":71.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP BILATERAL 2 VIEW","code_information":[{"code":"3201290","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.75,"setting":"both","billing_class":"facility"},{"gross_charge":78.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"HIP UNI 4/> VIEW LT","code_information":[{"code":"3201302","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 4/> VIEW RT","code_information":[{"code":"3201303","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":112.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 2-3 VIEW LT","code_information":[{"code":"3201304","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":90.0,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 2-3 VIEW RT","code_information":[{"code":"3201305","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":90.0,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 1 VIEW LT","code_information":[{"code":"3201306","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":62.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 1 VIEW RT","code_information":[{"code":"3201307","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":62.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP BIL 3-4 VIEWS","code_information":[{"code":"3201308","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"setting":"both","billing_class":"facility"},{"gross_charge":102.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"HUMERUS LT","code_information":[{"code":"3201371","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HUMERUS RT","code_information":[{"code":"3201372","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":61.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HYSTEROSALPINGOGRAM","code_information":[{"code":"3201390","type":"CDM"},{"code":"329","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.25,"setting":"both","billing_class":"facility"}]},{"description":"HYSTEROSALPINGOGRAM","code_information":[{"code":"3201390","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":1435.0,"setting":"both","billing_class":"professional"}]},{"description":"IV PYELOGRAM W OR WO TOMO","code_information":[{"code":"3201440","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1873.5,"setting":"both","billing_class":"facility"}]},{"description":"IV PYELOGRAM W OR WO TOMO","code_information":[{"code":"3201440","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1332.25,"setting":"both","billing_class":"professional"}]},{"description":"KIDDEGRAM FOR FOREIGN BODY","code_information":[{"code":"3201465","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"setting":"both","billing_class":"facility"},{"gross_charge":57.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"KNEES BILAT STANDING AP ONLY","code_information":[{"code":"3201469","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.25,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"KNEE 3 VIEW-LT","code_information":[{"code":"3201470","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":78.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE 3 VIEW-RT","code_information":[{"code":"3201471","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":78.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE FULL SERIES RT","code_information":[{"code":"3201481","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":88.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE FULL SERIES LT","code_information":[{"code":"3201482","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":88.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE-LIMITED VIEWS LT","code_information":[{"code":"3201491","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":65.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE-LIMITED VIEWS RT","code_information":[{"code":"3201492","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":65.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"LOWER LEG 2 VIEW LT","code_information":[{"code":"3201611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":60.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"LOWER LEG 2 VIEW RT","code_information":[{"code":"3201612","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":60.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"LOWER SPINE 2 OR 3 VIEW","code_information":[{"code":"3201630","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.25,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"LOWER SPINE BENDING 2/3V","code_information":[{"code":"3201641","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.75,"setting":"both","billing_class":"facility"},{"gross_charge":78.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"LOWER SPINE 6 OR MORE VIEW","code_information":[{"code":"3201650","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.75,"setting":"both","billing_class":"facility"},{"gross_charge":114.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"LOWER SPINE 4 OR MORE VIEW","code_information":[{"code":"3201660","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"MANDIBLE COMPLETE","code_information":[{"code":"3201750","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.5,"setting":"both","billing_class":"facility"},{"gross_charge":70.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"MANDIBLE LIMITED <4 VIEW","code_information":[{"code":"3201760","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility"},{"gross_charge":73.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"MASTOIDS","code_information":[{"code":"3201790","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.75,"setting":"both","billing_class":"facility"},{"gross_charge":100.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"MYELOGRAM CERVICAL","code_information":[{"code":"3201820","type":"CDM"},{"code":"320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6365.25,"setting":"both","billing_class":"facility"}]},{"description":"MYELOGRAM CERVICAL","code_information":[{"code":"3201820","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":4527.5,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAM-LUMBAR","code_information":[{"code":"3201830","type":"CDM"},{"code":"320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":5657.25,"setting":"both","billing_class":"facility"}]},{"description":"MYELOGRAM-LUMBAR","code_information":[{"code":"3201830","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":4023.5,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAM THORACIC","code_information":[{"code":"3201840","type":"CDM"},{"code":"320","type":"RC"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":4675.75,"setting":"both","billing_class":"facility"}]},{"description":"MYELOGRAM THORACIC","code_information":[{"code":"3201840","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":3325.5,"setting":"both","billing_class":"professional"}]},{"description":"MYLEOGRAM TOTAL","code_information":[{"code":"3201845","type":"CDM"},{"code":"320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":7322.75,"setting":"both","billing_class":"facility"}]},{"description":"MYLEOGRAM TOTAL","code_information":[{"code":"3201845","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":5208.5,"setting":"both","billing_class":"professional"}]},{"description":"NEPHROSTOGRAM/LOOPOGRAM","code_information":[{"code":"3201870","type":"CDM"},{"code":"329","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.5,"setting":"both","billing_class":"facility"}]},{"description":"NEPHROSTOGRAM/LOOPOGRAM","code_information":[{"code":"3201870","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":686.75,"setting":"both","billing_class":"professional"}]},{"description":"NECK SOFT TISSUE","code_information":[{"code":"3201880","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.75,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"NASAL BONES","code_information":[{"code":"3201890","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"setting":"both","billing_class":"facility"},{"gross_charge":73.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"OPTIC FORAMINA","code_information":[{"code":"3201950","type":"CDM"},{"code":"320","type":"RC"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.5,"setting":"both","billing_class":"facility"},{"gross_charge":66.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"ORBITS","code_information":[{"code":"3201990","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.5,"setting":"both","billing_class":"facility"},{"gross_charge":93.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"PANALYPSE (PANOREX)","code_information":[{"code":"3202040","type":"CDM"},{"code":"320","type":"RC"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"setting":"both","billing_class":"facility"},{"gross_charge":39.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"PELVIS 1 OR 2 VIEW","code_information":[{"code":"3202090","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","billing_class":"facility"},{"gross_charge":59.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"PELVIS 3 VIEW","code_information":[{"code":"3202091","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","billing_class":"facility"},{"gross_charge":74.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"RIBS/CHEST BIL 4 VIEW","code_information":[{"code":"3202140","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1600.75,"setting":"both","billing_class":"facility"},{"gross_charge":101.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"RIBS BIL 3 VIEW","code_information":[{"code":"3202143","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.75,"setting":"both","billing_class":"facility"},{"gross_charge":83.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"RIBS UNI 2 VIEW LT","code_information":[{"code":"3202147","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"RIBS UNI 2 VIEW RT","code_information":[{"code":"3202148","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":70.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"RETROGRADE URETHRAGRAM","code_information":[{"code":"3202149","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.75,"setting":"both","billing_class":"facility"}]},{"description":"RETROGRADE URETHRAGRAM","code_information":[{"code":"3202149","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1161.75,"setting":"both","billing_class":"professional"}]},{"description":"RETROGRADE CYSTO/PYELO IN OR","code_information":[{"code":"3202150","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.25,"setting":"both","billing_class":"facility"}]},{"description":"RETROGRADE CYSTO/PYELO IN OR","code_information":[{"code":"3202150","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1393.75,"setting":"both","billing_class":"professional"}]},{"description":"RIBS/CHEST UNI 3 LT","code_information":[{"code":"3202151","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":80.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"RIBS/CHEST UNI 3 RT","code_information":[{"code":"3202152","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":80.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SACRUM AND COCCYX","code_information":[{"code":"3202210","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":62.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SACROILIAC JOINT","code_information":[{"code":"3202220","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.25,"setting":"both","billing_class":"facility"},{"gross_charge":75.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SMALL BOWEL SERIES W KUB","code_information":[{"code":"3202240","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.75,"setting":"both","billing_class":"facility"}]},{"description":"SMALL BOWEL SERIES W KUB","code_information":[{"code":"3202240","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":621.0,"setting":"both","billing_class":"professional"}]},{"description":"SCAPULA RT","code_information":[{"code":"3202280","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":57.25,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SCAPULA LT","code_information":[{"code":"3202281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":57.25,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"STERNOCLAVICULAR JOINTS","code_information":[{"code":"3202290","type":"CDM"},{"code":"329","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SPINE 4 OR 5 VIEW","code_information":[{"code":"3202310","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1891.75,"setting":"both","billing_class":"facility"},{"gross_charge":138.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SHOULDER COMPLETE LT","code_information":[{"code":"3202391","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":66.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SHOULDER COMPLETE RT","code_information":[{"code":"3202392","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":66.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SIALAGRAM RT","code_information":[{"code":"3202480","type":"CDM"},{"code":"320","type":"RC"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"SIALAGRAM RT","code_information":[{"code":"3202480","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":807.25,"setting":"both","billing_class":"professional"}]},{"description":"SIALAGRAM LT","code_information":[{"code":"3202481","type":"CDM"},{"code":"320","type":"RC"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SIALAGRAM LT","code_information":[{"code":"3202481","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":807.25,"setting":"both","billing_class":"professional"}]},{"description":"SINUS COMPLETE","code_information":[{"code":"3202490","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"setting":"both","billing_class":"facility"},{"gross_charge":69.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SINUS LIMITED <14 YR","code_information":[{"code":"3202495","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"setting":"both","billing_class":"facility"},{"gross_charge":55.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SKULL COMPLETE","code_information":[{"code":"3202500","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.5,"setting":"both","billing_class":"facility"},{"gross_charge":84.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"SKULL LIMITED < 4 VIEWS","code_information":[{"code":"3202505","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.75,"setting":"both","billing_class":"facility"},{"gross_charge":67.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"BREAST SPECIMEN IMAGE","code_information":[{"code":"3202510","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"setting":"both","billing_class":"facility"}]},{"description":"BREAST SPECIMEN IMAGE","code_information":[{"code":"3202510","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":716.0,"setting":"both","billing_class":"professional"}]},{"description":"SPINE SINGLE VIEW","code_information":[{"code":"3202514","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"setting":"both","billing_class":"facility"},{"gross_charge":47.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"STERNUM","code_information":[{"code":"3202520","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"setting":"both","billing_class":"facility"},{"gross_charge":65.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"STONE REMOVAL/LITHOTRIPSEY OR","code_information":[{"code":"3202554","type":"CDM"},{"code":"329","type":"RC"},{"code":"47544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3892.75,"setting":"both","billing_class":"facility"}]},{"description":"STONE REMOVAL/LITHOTRIPSEY OR","code_information":[{"code":"3202554","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":2768.75,"setting":"both","billing_class":"professional"}]},{"description":"3 PHASE COOKIE SWALLOW FUNCTIO","code_information":[{"code":"3202555","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":908.5,"setting":"both","billing_class":"professional"}]},{"description":"3 PHASE COOKIE SWALLOW FUNCTIO","code_information":[{"code":"3202555","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"setting":"both","billing_class":"facility"}]},{"description":"TEETH, PARTIAL EXAM","code_information":[{"code":"3202615","type":"CDM"},{"code":"320","type":"RC"},{"code":"70310","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.25,"setting":"both","billing_class":"facility"},{"gross_charge":69.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"TMJ BILATERAL","code_information":[{"code":"3202620","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.75,"setting":"both","billing_class":"facility"},{"gross_charge":87.75,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"TOMOGRAPHY","code_information":[{"code":"3202680","type":"CDM"},{"code":"320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"setting":"both","billing_class":"facility"}]},{"description":"TOMOGRAPHY","code_information":[{"code":"3202680","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":763.25,"setting":"both","billing_class":"professional"}]},{"description":"SPINE THORACIC","code_information":[{"code":"3202710","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"setting":"both","billing_class":"facility"},{"gross_charge":63.25,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"X-RAY EXAM THORAC SPINE4/>VW","code_information":[{"code":"3202711","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.25,"setting":"both","billing_class":"facility"},{"gross_charge":22.5,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"UPPER GI 1 CONTRAST","code_information":[{"code":"3202731","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.25,"setting":"both","billing_class":"facility"}]},{"description":"SM INTESTINE FOLLOW THRU STUDY","code_information":[{"code":"3202740","type":"CDM"},{"code":"320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"}]},{"description":"UPPER GI 2 CONTRAST","code_information":[{"code":"3202760","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.25,"setting":"both","billing_class":"facility"}]},{"description":"VOIDING CYSTOURETHROGRAM","code_information":[{"code":"3202780","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.75,"setting":"both","billing_class":"facility"}]},{"description":"VOIDING CYSTOURETHROGRAM","code_information":[{"code":"3202780","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1035.5,"setting":"both","billing_class":"professional"}]},{"description":"XRAY WRIST COMPLETE BILATERAL","code_information":[{"code":"3202850","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":98.0,"setting":"both","modifiers":"50|TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha"}]},{"description":"XRAY WRIST COMPLETE LT","code_information":[{"code":"3202851","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":78.75,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"XRAY WRIST COMPLETE RT","code_information":[{"code":"3202852","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":78.75,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"WRIST 2 VIEW LT","code_information":[{"code":"3202862","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":65.5,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"WRIST 2 VIEW RT","code_information":[{"code":"3202863","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":65.5,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"VENOUS SAMPLE THRU CATHETER","code_information":[{"code":"3203095","type":"CDM"},{"code":"329","type":"RC"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":7053.25,"setting":"both","billing_class":"facility"}]},{"description":"VENOUS SAMPLE THRU CATHETER","code_information":[{"code":"3203095","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":5016.5,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER 1 VIEW LT","code_information":[{"code":"3203288","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":43.0,"setting":"both","modifiers":"TC|LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"SHOULDER 1 VIEW RT","code_information":[{"code":"3203289","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":43.0,"setting":"both","modifiers":"TC|RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"BONE DENSITY AXIAL","code_information":[{"code":"3208420","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE DENSITY AXIAL","code_information":[{"code":"3208420","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":593.5,"setting":"both","billing_class":"professional"}]},{"description":"BONE DENSITY APPENDICULAR","code_information":[{"code":"3208421","type":"CDM"},{"code":"320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.75,"setting":"both","billing_class":"facility"}]},{"description":"BONE DENSITY APPENDICULAR","code_information":[{"code":"3208421","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE DENSITYwVERT FX ASSES","code_information":[{"code":"3208422","type":"CDM"},{"code":"320","type":"RC"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.25,"setting":"both","billing_class":"facility"}]},{"description":"BONE DENSITYwVERT FX ASSES","code_information":[{"code":"3208422","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":593.5,"setting":"both","billing_class":"professional"}]},{"description":"FRACTURE ASSESS VIA DXA","code_information":[{"code":"3208425","type":"CDM"},{"code":"320","type":"RC"},{"code":"77086","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.75,"setting":"both","billing_class":"facility"}]},{"description":"FRACTURE ASSESS VIA DXA","code_information":[{"code":"3208425","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":125.75,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE TUBE/CATH NEPHRO W/CONT","code_information":[{"code":"3209071","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1523.5,"setting":"both","billing_class":"facility"}]},{"description":"CHANGE TUBE/CATH NEPHRO W/CONT","code_information":[{"code":"3209071","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1082.75,"setting":"both","billing_class":"professional"}]},{"description":"RENAL VEIN SELECT BIL","code_information":[{"code":"3209220","type":"CDM"},{"code":"329","type":"RC"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":5326.0,"setting":"both","billing_class":"facility"}]},{"description":"RENAL VEIN SELECT BIL","code_information":[{"code":"3209220","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":3788.0,"setting":"both","billing_class":"professional"}]},{"description":"RENAL VEIN SELECT UNI","code_information":[{"code":"3209225","type":"CDM"},{"code":"329","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":5326.0,"setting":"both","billing_class":"facility"}]},{"description":"RENAL VEIN SELECT UNI","code_information":[{"code":"3209225","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":3788.0,"setting":"both","billing_class":"professional"}]},{"description":"IMAGE GUIDED FLUID COLLECTION","code_information":[{"code":"3209405","type":"CDM"},{"code":"320","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3840.25,"setting":"both","billing_class":"facility"}]},{"description":"IMAGE GUIDED FLUID COLLECTION","code_information":[{"code":"3209405","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":3222.25,"setting":"both","billing_class":"professional"}]},{"description":"IMAGE GUIDED FLUID COL BY CATH","code_information":[{"code":"3209406","type":"CDM"},{"code":"320","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.5,"setting":"both","billing_class":"facility"}]},{"description":"IMAGE GUIDED FLUID COL BY CATH","code_information":[{"code":"3209406","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1493.75,"setting":"both","billing_class":"professional"}]},{"description":"REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"3209408","type":"CDM"},{"code":"361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1595.25,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN/MUSCULO UNLISTED PROC","code_information":[{"code":"3222999","type":"CDM"},{"code":"361","type":"RC"},{"code":"22999","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN/MUSCULO UNLISTED PROC","code_information":[{"code":"3222999","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":527.25,"setting":"both","billing_class":"professional"}]},{"description":"FETAL NUCHAL TRANSL 1ST GESTAT","code_information":[{"code":"3276813","type":"CDM"},{"code":"402","type":"RC"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"setting":"both","billing_class":"facility"}]},{"description":"FETAL NUCHAL TRANSL 1ST GESTAT","code_information":[{"code":"3276813","type":"CDM"},{"code":"402","type":"RC"}],"standard_charges":[{"gross_charge":567.75,"setting":"both","billing_class":"professional"}]},{"description":"FETAL NUCHAL TRANSL ADD GEST","code_information":[{"code":"3276814","type":"CDM"},{"code":"402","type":"RC"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"setting":"both","billing_class":"facility"}]},{"description":"FETAL NUCHAL TRANSL ADD GEST","code_information":[{"code":"3276814","type":"CDM"},{"code":"402","type":"RC"}],"standard_charges":[{"gross_charge":567.75,"setting":"both","billing_class":"professional"}]},{"description":"MEDIPORT FLUSH-INF","code_information":[{"code":"3300090","type":"CDM"},{"code":"940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.75,"setting":"both","billing_class":"facility"},{"gross_charge":426.5,"setting":"both","billing_class":"professional"}]},{"description":"MEDIPORT FLUSH-AC","code_information":[{"code":"3300091","type":"CDM"},{"code":"940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.75,"setting":"both","billing_class":"facility"},{"gross_charge":426.5,"setting":"both","billing_class":"professional"}]},{"description":"MEDIPORT FLUSH-3S","code_information":[{"code":"3300093","type":"CDM"},{"code":"940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.75,"setting":"both","billing_class":"facility"},{"gross_charge":426.5,"setting":"both","billing_class":"professional"}]},{"description":"IV PUSH INITIAL DRUG-INF","code_information":[{"code":"3310011","type":"CDM"},{"code":"335","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.5,"setting":"both","billing_class":"facility"},{"gross_charge":482.25,"setting":"both","billing_class":"professional"}]},{"description":"IV PUSH INITIAL DRUG-3S","code_information":[{"code":"3310012","type":"CDM"},{"code":"335","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.5,"setting":"both","billing_class":"facility"},{"gross_charge":482.25,"setting":"both","billing_class":"professional"}]},{"description":"IV PUSH ADDL DRUG-INF","code_information":[{"code":"3310015","type":"CDM"},{"code":"335","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.75,"setting":"both","billing_class":"facility"},{"gross_charge":480.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-INF","code_information":[{"code":"3310040","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":394.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-3S","code_information":[{"code":"3310041","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":394.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-2N","code_information":[{"code":"3310042","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-ICU","code_information":[{"code":"3310043","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":394.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-PCU","code_information":[{"code":"3310044","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":394.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADM ADDL-INF","code_information":[{"code":"3310045","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"},{"gross_charge":369.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-AC","code_information":[{"code":"3310046","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"},{"gross_charge":394.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ADMIN;INTRALESION","code_information":[{"code":"3310050","type":"CDM"},{"code":"280","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"setting":"both","billing_class":"facility"},{"gross_charge":350.5,"setting":"both","billing_class":"professional"}]},{"description":"DECLOT VASCULAR DEVICE","code_information":[{"code":"3336593","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.25,"setting":"both","billing_class":"facility"},{"gross_charge":858.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-AC","code_information":[{"code":"3350009","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-3S","code_information":[{"code":"3350010","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-INF","code_information":[{"code":"3350011","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-2N","code_information":[{"code":"3350012","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-ICU","code_information":[{"code":"3350013","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL HR-PCU","code_information":[{"code":"3350014","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.5,"setting":"both","billing_class":"facility"},{"gross_charge":580.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-INF","code_information":[{"code":"3350015","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-3S","code_information":[{"code":"3350016","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-ICU","code_information":[{"code":"3350017","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-PCU","code_information":[{"code":"3350018","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-2N","code_information":[{"code":"3350019","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO IV INFUSION 1ST HR-AC","code_information":[{"code":"3350020","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.25,"setting":"both","billing_class":"facility"},{"gross_charge":717.0,"setting":"both","billing_class":"professional"}]},{"description":"CHEMOTHER UNLISTED PROC","code_information":[{"code":"3350022","type":"CDM"},{"code":"335","type":"RC"},{"code":"96549","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.5,"setting":"both","billing_class":"facility"},{"gross_charge":98.75,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO THERAPY IV ADDL SEQ-INF","code_information":[{"code":"3350039","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.5,"setting":"both","billing_class":"facility"},{"gross_charge":426.25,"setting":"both","billing_class":"professional"}]},{"description":"CHEMO ADMIN INTO CNS","code_information":[{"code":"3350101","type":"CDM"},{"code":"331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.75,"setting":"both","billing_class":"facility"}]},{"description":"BONE SCAN TOTAL","code_information":[{"code":"3400040","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2676.25,"setting":"both","billing_class":"facility"},{"gross_charge":2036.25,"setting":"both","billing_class":"professional"}]},{"description":"BONE SCAN THREE PHASE","code_information":[{"code":"3400041","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3825.0,"setting":"both","billing_class":"facility"},{"gross_charge":2911.0,"setting":"both","billing_class":"professional"}]},{"description":"BONE SCAN MULTIPLES","code_information":[{"code":"3400045","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":3825.0,"setting":"both","billing_class":"facility"},{"gross_charge":2911.0,"setting":"both","billing_class":"professional"}]},{"description":"BONE SPECT","code_information":[{"code":"3400050","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4395.5,"setting":"both","billing_class":"facility"}]},{"description":"BONE SCAN SINGLE AREA","code_information":[{"code":"3400055","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3951.75,"setting":"both","billing_class":"facility"},{"gross_charge":3007.25,"setting":"both","billing_class":"professional"}]},{"description":"BRAIN SCAN W/FLOW","code_information":[{"code":"3400065","type":"CDM"},{"code":"341","type":"RC"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2550.75,"setting":"both","billing_class":"facility"},{"gross_charge":1941.25,"setting":"both","billing_class":"professional"}]},{"description":"BRAIN FLOW SCAN","code_information":[{"code":"3400070","type":"CDM"},{"code":"341","type":"RC"},{"code":"78610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1481.5,"setting":"both","billing_class":"facility"},{"gross_charge":1127.25,"setting":"both","billing_class":"professional"}]},{"description":"CISTERNOGRAM","code_information":[{"code":"3400090","type":"CDM"},{"code":"341","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"setting":"both","billing_class":"facility"},{"gross_charge":2885.75,"setting":"both","billing_class":"professional"}]},{"description":"BONE MARROW IMAGING LIMITED","code_information":[{"code":"3400102","type":"CDM"},{"code":"341","type":"RC"},{"code":"78102","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.75,"setting":"both","billing_class":"facility"},{"gross_charge":536.0,"setting":"both","billing_class":"professional"}]},{"description":"KINOVAC SCAN (GB)","code_information":[{"code":"3400120","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.25,"setting":"both","billing_class":"facility"},{"gross_charge":2431.75,"setting":"both","billing_class":"professional"}]},{"description":"HEPATOBILIARY SCAN","code_information":[{"code":"3400140","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.25,"setting":"both","billing_class":"facility"},{"gross_charge":2431.75,"setting":"both","billing_class":"professional"}]},{"description":"GASTROESOPHAGEAL REFLUX STUDY","code_information":[{"code":"3400150","type":"CDM"},{"code":"341","type":"RC"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.5,"setting":"both","billing_class":"facility"},{"gross_charge":1639.25,"setting":"both","billing_class":"professional"}]},{"description":"GASTRIC EMPTYING STUDY","code_information":[{"code":"3400155","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.5,"setting":"both","billing_class":"facility"},{"gross_charge":1466.75,"setting":"both","billing_class":"professional"}]},{"description":"GI BLEED (TAGGED RBC)","code_information":[{"code":"3400180","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.0,"setting":"both","billing_class":"facility"},{"gross_charge":1091.0,"setting":"both","billing_class":"professional"}]},{"description":"GALLIUM WHOLE BODY","code_information":[{"code":"3400220","type":"CDM"},{"code":"341","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":2834.0,"setting":"both","billing_class":"facility"},{"gross_charge":1765.0,"setting":"both","billing_class":"professional"}]},{"description":"RADIOPHARM TUM WH BOD 1 DAY IM","code_information":[{"code":"3400236","type":"CDM"},{"code":"341","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":2834.0,"setting":"both","billing_class":"facility"},{"gross_charge":2156.75,"setting":"both","billing_class":"professional"}]},{"description":"LIVER SPLEEN SCAN","code_information":[{"code":"3400240","type":"CDM"},{"code":"341","type":"RC"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1842.5,"setting":"both","billing_class":"facility"},{"gross_charge":1401.75,"setting":"both","billing_class":"professional"}]},{"description":"LIVER SPECT","code_information":[{"code":"3400250","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4395.5,"setting":"both","billing_class":"facility"}]},{"description":"LUNG SCAN - PERFUSION","code_information":[{"code":"3400260","type":"CDM"},{"code":"341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"setting":"both","billing_class":"facility"},{"gross_charge":1230.75,"setting":"both","billing_class":"professional"}]},{"description":"LUNG PERFUSION DIFFERENTIAL","code_information":[{"code":"3400261","type":"CDM"},{"code":"341","type":"RC"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.5,"setting":"both","billing_class":"facility"},{"gross_charge":822.0,"setting":"both","billing_class":"professional"}]},{"description":"LUNG VENT AND SCAN PERFUSION","code_information":[{"code":"3400271","type":"CDM"},{"code":"341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":4541.0,"setting":"both","billing_class":"facility"},{"gross_charge":3456.0,"setting":"both","billing_class":"professional"}]},{"description":"MECKLE'S DIVERICULUM","code_information":[{"code":"3400290","type":"CDM"},{"code":"340","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"setting":"both","billing_class":"facility"},{"gross_charge":1255.25,"setting":"both","billing_class":"professional"}]},{"description":"TUMOR RADIOPHARM","code_information":[{"code":"3400292","type":"CDM"},{"code":"341","type":"RC"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1449.75,"setting":"both","billing_class":"facility"},{"gross_charge":1102.75,"setting":"both","billing_class":"professional"}]},{"description":"MUGA SCAN EJECTION FRACTION","code_information":[{"code":"3400296","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.5,"setting":"both","billing_class":"facility"},{"gross_charge":2258.25,"setting":"both","billing_class":"professional"}]},{"description":"MYOCARDIAL IMAGE SPECT MULT","code_information":[{"code":"3400315","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":8170.25,"setting":"both","billing_class":"facility"},{"gross_charge":6217.75,"setting":"both","billing_class":"professional"}]},{"description":"MYOCARDIAL IMAGE SPECT SING","code_information":[{"code":"3400346","type":"CDM"},{"code":"341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3387.25,"setting":"both","billing_class":"facility"},{"gross_charge":2577.5,"setting":"both","billing_class":"professional"}]},{"description":"PARATHYROID","code_information":[{"code":"3400420","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"setting":"both","billing_class":"facility"},{"gross_charge":921.25,"setting":"both","billing_class":"professional"}]},{"description":"PARATHYROID IMAGING W SPECT/CT","code_information":[{"code":"3400421","type":"CDM"},{"code":"341","type":"RC"},{"code":"78072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.75,"setting":"both","billing_class":"facility"},{"gross_charge":1065.75,"setting":"both","billing_class":"professional"}]},{"description":"PARATHYROID IMAGING W SPECT","code_information":[{"code":"3400422","type":"CDM"},{"code":"341","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.75,"setting":"both","billing_class":"facility"},{"gross_charge":1065.75,"setting":"both","billing_class":"professional"}]},{"description":"PERITONEAL SHUNT PATENCY","code_information":[{"code":"3400428","type":"CDM"},{"code":"341","type":"RC"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"setting":"both","billing_class":"facility"},{"gross_charge":1261.5,"setting":"both","billing_class":"professional"}]},{"description":"RADIOPHARMACEUTICAL THERAPY IV","code_information":[{"code":"3400441","type":"CDM"},{"code":"342","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"setting":"both","billing_class":"facility"},{"gross_charge":1071.0,"setting":"both","billing_class":"professional"}]},{"description":"RENAL BASELINE AND PHARM","code_information":[{"code":"3400445","type":"CDM"},{"code":"341","type":"RC"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1478.5,"setting":"both","billing_class":"facility"},{"gross_charge":1124.75,"setting":"both","billing_class":"professional"}]},{"description":"RENAL FLOW","code_information":[{"code":"3400450","type":"CDM"},{"code":"341","type":"RC"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.25,"setting":"both","billing_class":"facility"},{"gross_charge":945.0,"setting":"both","billing_class":"professional"}]},{"description":"RENAL FLOW AND FUNCTION","code_information":[{"code":"3400460","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2569.75,"setting":"both","billing_class":"facility"},{"gross_charge":1955.5,"setting":"both","billing_class":"professional"}]},{"description":"RENAL SINGLE WO PHA","code_information":[{"code":"3400466","type":"CDM"},{"code":"341","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":2569.75,"setting":"both","billing_class":"facility"},{"gross_charge":1955.5,"setting":"both","billing_class":"professional"}]},{"description":"RENAL SCAN","code_information":[{"code":"3400470","type":"CDM"},{"code":"341","type":"RC"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"setting":"both","billing_class":"facility"},{"gross_charge":1413.0,"setting":"both","billing_class":"professional"}]},{"description":"TESTICULAR SCAN AND FLOW","code_information":[{"code":"3400505","type":"CDM"},{"code":"341","type":"RC"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":4470.0,"setting":"both","billing_class":"facility"},{"gross_charge":3401.75,"setting":"both","billing_class":"professional"}]},{"description":"THYROID SCAN","code_information":[{"code":"3400507","type":"CDM"},{"code":"341","type":"RC"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.25,"setting":"both","billing_class":"facility"},{"gross_charge":811.0,"setting":"both","billing_class":"professional"}]},{"description":"THYROID POST ABLATION SCAN","code_information":[{"code":"3400508","type":"CDM"},{"code":"341","type":"RC"},{"code":"78015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.25,"setting":"both","billing_class":"facility"},{"gross_charge":811.0,"setting":"both","billing_class":"professional"}]},{"description":"TX DOSE W/B","code_information":[{"code":"3400509","type":"CDM"},{"code":"341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.5,"setting":"both","billing_class":"facility"},{"gross_charge":811.75,"setting":"both","billing_class":"professional"}]},{"description":"THYROID IMAGING W/BLOOD FLOW","code_information":[{"code":"3400510","type":"CDM"},{"code":"341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.75,"setting":"both","billing_class":"facility"},{"gross_charge":1376.0,"setting":"both","billing_class":"professional"}]},{"description":"ORAL RADIOPHARMACEUTICAL","code_information":[{"code":"3400525","type":"CDM"},{"code":"342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.25,"setting":"both","billing_class":"facility"},{"gross_charge":2179.5,"setting":"both","billing_class":"professional"}]},{"description":"THYROID UPTAKE MEASUREMENT","code_information":[{"code":"3400530","type":"CDM"},{"code":"341","type":"RC"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.25,"setting":"both","billing_class":"facility"},{"gross_charge":681.75,"setting":"both","billing_class":"professional"}]},{"description":"RADIOPHAR LOCALIZATION TUMOR","code_information":[{"code":"3400536","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4395.5,"setting":"both","billing_class":"facility"}]},{"description":"TUMOR IMAGING WHOLE BODY >2DAY","code_information":[{"code":"3400537","type":"CDM"},{"code":"340","type":"RC"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":2521.0,"setting":"both","billing_class":"facility"},{"gross_charge":1918.25,"setting":"both","billing_class":"professional"}]},{"description":"URETERAL REFLUX STUDY","code_information":[{"code":"3400580","type":"CDM"},{"code":"341","type":"RC"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.5,"setting":"both","billing_class":"facility"},{"gross_charge":803.75,"setting":"both","billing_class":"professional"}]},{"description":"FLUORODEOXYGLUC PER STUD < 45","code_information":[{"code":"3430404","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"setting":"both","billing_class":"facility"}]},{"description":"FLUORODEOXYGLUC PER STUD < 45","code_information":[{"code":"3430404","type":"CDM"},{"code":"343","type":"RC"}],"standard_charges":[{"gross_charge":192.75,"setting":"both","billing_class":"professional"}]},{"description":"PYLARIFY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"3430405","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"71258002200","type":"NDC"}],"standard_charges":[{"gross_charge":24909.84,"setting":"both","billing_class":"facility"}]},{"description":"PIFLU F-18, DIA 1 MCI-PYLARIFY","code_information":[{"code":"3430405","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9595","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.5,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"FLORBTPR F18 0-10 MCI-AMYLOID","code_information":[{"code":"3430406","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9586","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.5,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":7167.75,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"FLUTMTML F18 0-5MCI-AMYLOID","code_information":[{"code":"3430407","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9982","type":"HCPCS"}],"standard_charges":[{"gross_charge":8947.75,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":8278.0,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"FLORBTBN F18 0-8.1MCI-AMYLOID","code_information":[{"code":"3430408","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9983","type":"HCPCS"}],"standard_charges":[{"gross_charge":7592.25,"setting":"both","modifiers":"TB|U6","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"},{"gross_charge":7023.75,"setting":"both","modifiers":"TB|U6","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"PEND CAPR (IN 111) 0-10ML DOS","code_information":[{"code":"3430410","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9507","type":"HCPCS"}],"standard_charges":[{"gross_charge":6195.5,"setting":"both","billing_class":"facility"}]},{"description":"PEND CAPR (IN 111) 0-10ML DOS","code_information":[{"code":"3430410","type":"CDM"},{"code":"343","type":"RC"}],"standard_charges":[{"gross_charge":4577.75,"setting":"both","billing_class":"professional"}]},{"description":"LYMPHOSCINTIGRAPHY","code_information":[{"code":"3478195","type":"CDM"},{"code":"340","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2286.25,"setting":"both","billing_class":"facility"},{"gross_charge":1739.5,"setting":"both","billing_class":"professional"}]},{"description":"SALIVARY GLAND FUNCTION STUDY","code_information":[{"code":"3478232","type":"CDM"},{"code":"341","type":"RC"},{"code":"78232","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.5,"setting":"both","billing_class":"facility"},{"gross_charge":467.75,"setting":"both","billing_class":"professional"}]},{"description":"STELLANT SYRINGE KIT-DUAL","code_information":[{"code":"3500011","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":57.25,"setting":"both","billing_class":"facility"},{"gross_charge":42.0,"setting":"both","billing_class":"professional"}]},{"description":"CT 3D RENDERING W INTERP & REP","code_information":[{"code":"3500015","type":"CDM"},{"code":"350","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1594.75,"setting":"both","billing_class":"facility"},{"gross_charge":1213.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ABDOMEN W/WO CONTRAST","code_information":[{"code":"3500020","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":4533.75,"setting":"both","billing_class":"facility"},{"gross_charge":3450.25,"setting":"both","billing_class":"professional"}]},{"description":"CT LUNG CANCER SCREENING","code_information":[{"code":"3500021","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.25,"setting":"both","billing_class":"facility"},{"gross_charge":355.75,"setting":"both","billing_class":"professional"}]},{"description":"BLUEPRINT SHOULDER WO CONTR RT","code_information":[{"code":"3500022","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":2312.5,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"BLUEPRINT SHOULDER WO CONTR LT","code_information":[{"code":"3500023","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":2312.5,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT ABDOMEN WITH CONTRAST","code_information":[{"code":"3500040","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3680.0,"setting":"both","billing_class":"facility"},{"gross_charge":2800.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ABD AND PELVIS W CONTRAST","code_information":[{"code":"3500046","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.25,"setting":"both","billing_class":"facility"},{"gross_charge":5321.75,"setting":"both","billing_class":"professional"}]},{"description":"CT ABD AND PELVIS W/O CONTRAST","code_information":[{"code":"3500047","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.5,"setting":"both","billing_class":"facility"},{"gross_charge":4646.75,"setting":"both","billing_class":"professional"}]},{"description":"CT ABD AND PELVIS W/WO CONTRAS","code_information":[{"code":"3500048","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":8707.5,"setting":"both","billing_class":"facility"},{"gross_charge":6627.0,"setting":"both","billing_class":"professional"}]},{"description":"CT ABDOMEN WITHOUT CONTRAST","code_information":[{"code":"3500050","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3217.75,"setting":"both","billing_class":"facility"},{"gross_charge":2448.75,"setting":"both","billing_class":"professional"}]},{"description":"CT FOR NEEDLE BIOPSY","code_information":[{"code":"3500101","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3284.5,"setting":"both","billing_class":"facility"},{"gross_charge":2499.5,"setting":"both","billing_class":"professional"}]},{"description":"CT GUIDED FLUID COLL VIA CATH","code_information":[{"code":"3500102","type":"CDM"},{"code":"350","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.75,"setting":"both","billing_class":"facility"},{"gross_charge":1243.75,"setting":"both","billing_class":"professional"}]},{"description":"CT THORAX W/WO CONTRAST","code_information":[{"code":"3500130","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3607.25,"setting":"both","billing_class":"facility"},{"gross_charge":2744.75,"setting":"both","billing_class":"professional"}]},{"description":"CT THORAX W CONTRAST","code_information":[{"code":"3500150","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3323.25,"setting":"both","billing_class":"facility"},{"gross_charge":2529.25,"setting":"both","billing_class":"professional"}]},{"description":"CT THORAX WO CONTRAST","code_information":[{"code":"3500160","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2940.5,"setting":"both","billing_class":"facility"},{"gross_charge":2237.75,"setting":"both","billing_class":"professional"}]},{"description":"CT CERVICAL SPINE W/WO CONTR","code_information":[{"code":"3500180","type":"CDM"},{"code":"350","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":3889.5,"setting":"both","billing_class":"facility"},{"gross_charge":2960.25,"setting":"both","billing_class":"professional"}]},{"description":"CT CERVICAL SPINE WITH CONTR","code_information":[{"code":"3500190","type":"CDM"},{"code":"350","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.25,"setting":"both","billing_class":"facility"},{"gross_charge":2819.25,"setting":"both","billing_class":"professional"}]},{"description":"CT CERVICAL SPINE W/O CONTR","code_information":[{"code":"3500200","type":"CDM"},{"code":"350","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.5,"setting":"both","billing_class":"facility"},{"gross_charge":2684.5,"setting":"both","billing_class":"professional"}]},{"description":"CT HEAD W/WO CONTRAST","code_information":[{"code":"3500230","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4137.75,"setting":"both","billing_class":"facility"},{"gross_charge":3148.75,"setting":"both","billing_class":"professional"}]},{"description":"CT CHEST HI RESOLUTION W/O CON","code_information":[{"code":"3500240","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2940.5,"setting":"both","billing_class":"facility"},{"gross_charge":2237.75,"setting":"both","billing_class":"professional"}]},{"description":"CT CATH FLUID COLLXN DRAINAGE","code_information":[{"code":"3500241","type":"CDM"},{"code":"350","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3840.25,"setting":"both","billing_class":"facility"},{"gross_charge":3222.25,"setting":"both","billing_class":"professional"}]},{"description":"CT HEAD WITH CONTRAST","code_information":[{"code":"3500250","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3479.5,"setting":"both","billing_class":"facility"},{"gross_charge":2647.5,"setting":"both","billing_class":"professional"}]},{"description":"CT HEAD WITHOUT CONTRAST","code_information":[{"code":"3500260","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3183.25,"setting":"both","billing_class":"facility"},{"gross_charge":2422.5,"setting":"both","billing_class":"professional"}]},{"description":"CT LIMITED","code_information":[{"code":"3500265","type":"CDM"},{"code":"352","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":2226.5,"setting":"both","billing_class":"facility"},{"gross_charge":1694.0,"setting":"both","billing_class":"professional"}]},{"description":"CT LOWER EXT W/WO CONT LT","code_information":[{"code":"3500280","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2598.75,"setting":"both","billing_class":"professional"},{"gross_charge":3415.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT LOWER EXT W/WO CONTR RT","code_information":[{"code":"3500281","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2598.75,"setting":"both","billing_class":"professional"},{"gross_charge":3415.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT LUMBAR SPINE W/WO CONTRAST","code_information":[{"code":"3500320","type":"CDM"},{"code":"350","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":3889.5,"setting":"both","billing_class":"facility"},{"gross_charge":2960.25,"setting":"both","billing_class":"professional"}]},{"description":"CT LUMBAR SPINE WITH CONTRAST","code_information":[{"code":"3500330","type":"CDM"},{"code":"350","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.25,"setting":"both","billing_class":"facility"},{"gross_charge":2819.25,"setting":"both","billing_class":"professional"}]},{"description":"CT LUMBAR SPINE W/O CONTRAST","code_information":[{"code":"3500340","type":"CDM"},{"code":"350","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.5,"setting":"both","billing_class":"facility"},{"gross_charge":2684.5,"setting":"both","billing_class":"professional"}]},{"description":"CT MAXILLOFACIAL W/WO CONTR","code_information":[{"code":"3500360","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.25,"setting":"both","billing_class":"facility"},{"gross_charge":2549.5,"setting":"both","billing_class":"professional"}]},{"description":"CT MAXILLOFACIAL W CONTR","code_information":[{"code":"3500370","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":3190.5,"setting":"both","billing_class":"facility"},{"gross_charge":2428.0,"setting":"both","billing_class":"professional"}]},{"description":"CT MAXILLOFACIAL W/O CONTR","code_information":[{"code":"3500380","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.75,"setting":"both","billing_class":"facility"},{"gross_charge":2312.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ORB/EAR/SEL/FOS W/WO CONT","code_information":[{"code":"3500386","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.25,"setting":"both","billing_class":"facility"},{"gross_charge":2549.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ORB/EAR/SEL/FOS W CONT","code_information":[{"code":"3500394","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":3190.5,"setting":"both","billing_class":"facility"},{"gross_charge":2428.0,"setting":"both","billing_class":"professional"}]},{"description":"CT FOR THERAPY GUIDE","code_information":[{"code":"3500399","type":"CDM"},{"code":"350","type":"RC"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":3905.75,"setting":"both","billing_class":"facility"},{"gross_charge":2972.75,"setting":"both","billing_class":"professional"}]},{"description":"CT SOFT TISSUE NECK W/WO CONTR","code_information":[{"code":"3500400","type":"CDM"},{"code":"350","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.25,"setting":"both","billing_class":"facility"},{"gross_charge":2549.5,"setting":"both","billing_class":"professional"}]},{"description":"CT SOFT TISSUE NECK W/ CONTR","code_information":[{"code":"3500410","type":"CDM"},{"code":"350","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":3551.5,"setting":"both","billing_class":"facility"},{"gross_charge":2702.5,"setting":"both","billing_class":"professional"}]},{"description":"CT SOFT TISSUE NECK W/O CONTR","code_information":[{"code":"3500420","type":"CDM"},{"code":"350","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.75,"setting":"both","billing_class":"facility"},{"gross_charge":2312.5,"setting":"both","billing_class":"professional"}]},{"description":"CT PELVIS W/WO CONTRAST","code_information":[{"code":"3500440","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":3266.0,"setting":"both","billing_class":"facility"},{"gross_charge":2485.0,"setting":"both","billing_class":"professional"}]},{"description":"CT PELVIS WITH CONTRAST","code_information":[{"code":"3500460","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.75,"setting":"both","billing_class":"facility"},{"gross_charge":2788.25,"setting":"both","billing_class":"professional"}]},{"description":"CT PELVIS WITHOUT CONTRAST","code_information":[{"code":"3500470","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":3194.75,"setting":"both","billing_class":"facility"},{"gross_charge":2431.25,"setting":"both","billing_class":"professional"}]},{"description":"CT ORB/EAR/SEL/FOS W/O CONT","code_information":[{"code":"3500501","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.75,"setting":"both","billing_class":"facility"},{"gross_charge":2312.5,"setting":"both","billing_class":"professional"}]},{"description":"CT THORACIC SPINE W/WO CONTR","code_information":[{"code":"3500550","type":"CDM"},{"code":"350","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":3889.5,"setting":"both","billing_class":"facility"},{"gross_charge":2960.25,"setting":"both","billing_class":"professional"}]},{"description":"CT THORACIC SPINE WITH CONTR","code_information":[{"code":"3500560","type":"CDM"},{"code":"350","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.25,"setting":"both","billing_class":"facility"},{"gross_charge":2819.25,"setting":"both","billing_class":"professional"}]},{"description":"CT THORACIC SPINE W/O CONTR","code_information":[{"code":"3500570","type":"CDM"},{"code":"350","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.5,"setting":"both","billing_class":"facility"},{"gross_charge":2684.5,"setting":"both","billing_class":"professional"}]},{"description":"CT UPPER EXTR W/WO CONT LT","code_information":[{"code":"3500590","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2549.5,"setting":"both","billing_class":"professional"},{"gross_charge":3350.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT UPPER EXTR W/WO CONTR RT","code_information":[{"code":"3500591","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2549.5,"setting":"both","billing_class":"professional"},{"gross_charge":3350.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT UPPER EXTREMITY W CONT RT","code_information":[{"code":"3500601","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2428.0,"setting":"both","billing_class":"professional"},{"gross_charge":3190.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT UPPER EXTREMITY W CONT LT","code_information":[{"code":"3500603","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2428.0,"setting":"both","billing_class":"professional"},{"gross_charge":3190.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT UPPER EXTREMITY WO CONT RT","code_information":[{"code":"3500611","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2312.5,"setting":"both","billing_class":"professional"},{"gross_charge":3038.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT UPPER EXTREMITY WO CONT LT","code_information":[{"code":"3500615","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2312.5,"setting":"both","billing_class":"professional"},{"gross_charge":3038.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT LWR EXTREMITY W CONT RT","code_information":[{"code":"3500620","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"setting":"both","billing_class":"professional"},{"gross_charge":3252.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT LWR EXTREMITY W CONT LT","code_information":[{"code":"3500622","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.0,"setting":"both","billing_class":"professional"},{"gross_charge":3252.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT LWR EXTREMITY WO CONT RT","code_information":[{"code":"3500700","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.25,"setting":"both","billing_class":"professional"},{"gross_charge":3098.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT MAKO H/K/A WO CONT LT","code_information":[{"code":"3500724","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3009.5,"setting":"both","billing_class":"professional"},{"gross_charge":3098.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT MAKO H/K/A WO CONT RT","code_information":[{"code":"3500725","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3009.5,"setting":"both","billing_class":"professional"},{"gross_charge":3098.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT LWR EXTREMITY WO CONT LT","code_information":[{"code":"3500744","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.25,"setting":"both","billing_class":"professional"},{"gross_charge":3098.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT GUIDED PLMT NEPHRO CATH","code_information":[{"code":"3500899","type":"CDM"},{"code":"361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":5315.25,"setting":"both","billing_class":"facility"},{"gross_charge":4045.0,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION BONE","code_information":[{"code":"3520220","type":"CDM"},{"code":"361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.75,"setting":"both","billing_class":"facility"},{"gross_charge":1551.0,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY BONE DEEP","code_information":[{"code":"3520225","type":"CDM"},{"code":"361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2111.25,"setting":"both","billing_class":"facility"},{"gross_charge":1606.5,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIR SOFT TIS NECK","code_information":[{"code":"3521550","type":"CDM"},{"code":"361","type":"RC"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2521.25,"setting":"both","billing_class":"facility"},{"gross_charge":1918.5,"setting":"both","billing_class":"professional"}]},{"description":"CT BX SOFT TISSUE BACK/FLANK","code_information":[{"code":"3521920","type":"CDM"},{"code":"361","type":"RC"},{"code":"21920","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.75,"setting":"both","billing_class":"facility"},{"gross_charge":1551.0,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION PELVIS","code_information":[{"code":"3527040","type":"CDM"},{"code":"361","type":"RC"},{"code":"27040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.75,"setting":"both","billing_class":"facility"},{"gross_charge":1551.0,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY PLEURA; PERCUTANEOUS","code_information":[{"code":"3532400","type":"CDM"},{"code":"361","type":"RC"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.5,"setting":"both","billing_class":"facility"},{"gross_charge":1563.5,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION LUNG RT","code_information":[{"code":"3532405","type":"CDM"},{"code":"361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":2305.25,"setting":"both","billing_class":"facility"},{"gross_charge":1841.5,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION LUNG LT","code_information":[{"code":"3532406","type":"CDM"},{"code":"361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":2305.25,"setting":"both","billing_class":"facility"},{"gross_charge":1841.5,"setting":"both","billing_class":"professional"}]},{"description":"CT THORACENTESIS W/ IMAGING RT","code_information":[{"code":"3532555","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"setting":"both","billing_class":"professional"},{"gross_charge":1451.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT THORACENTESIS W/ IMAGING LT","code_information":[{"code":"3532556","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"setting":"both","billing_class":"professional"},{"gross_charge":1451.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT BIOPSY/ASPIRATION LIVER","code_information":[{"code":"3547000","type":"CDM"},{"code":"350","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.5,"setting":"both","billing_class":"facility"},{"gross_charge":1503.75,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION PANCREAS","code_information":[{"code":"3548102","type":"CDM"},{"code":"361","type":"RC"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":3102.25,"setting":"both","billing_class":"facility"},{"gross_charge":2361.0,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY ABD","code_information":[{"code":"3549180","type":"CDM"},{"code":"350","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.0,"setting":"both","billing_class":"facility"},{"gross_charge":1565.0,"setting":"both","billing_class":"professional"}]},{"description":"CT BIOPSY/ASPIRATION RENAL RT","code_information":[{"code":"3550200","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3414.0,"setting":"both","billing_class":"professional"},{"gross_charge":3514.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT BIOPSY/ASPIRATION RENAL LT","code_information":[{"code":"3550201","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3414.0,"setting":"both","billing_class":"professional"},{"gross_charge":3514.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT BIOPSY/ASPIRA ADRENAL GLAN","code_information":[{"code":"3560699","type":"CDM"},{"code":"361","type":"RC"},{"code":"60699","type":"HCPCS"}],"standard_charges":[{"gross_charge":7326.0,"setting":"both","billing_class":"facility"},{"gross_charge":5575.75,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"3570496","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":5258.5,"setting":"both","billing_class":"facility"},{"gross_charge":4002.0,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO NECK","code_information":[{"code":"3570498","type":"CDM"},{"code":"351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3961.25,"setting":"both","billing_class":"facility"},{"gross_charge":3014.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO CHEST","code_information":[{"code":"3571275","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5329.75,"setting":"both","billing_class":"facility"},{"gross_charge":4056.25,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO PELVIS","code_information":[{"code":"3572191","type":"CDM"},{"code":"352","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":4778.0,"setting":"both","billing_class":"facility"},{"gross_charge":3636.25,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO UPPER EXTREM LT","code_information":[{"code":"3573206","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2891.5,"setting":"both","billing_class":"professional"},{"gross_charge":3799.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT ANGIO UPPER EXTREM RT","code_information":[{"code":"3573207","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2891.5,"setting":"both","billing_class":"professional"},{"gross_charge":3799.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT ANGIO LOWER EXTR LT","code_information":[{"code":"3573706","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3078.0,"setting":"both","billing_class":"professional"},{"gross_charge":4044.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"CT ANGIO LOWER EXTR RT","code_information":[{"code":"3573707","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3078.0,"setting":"both","billing_class":"professional"},{"gross_charge":4044.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"CT ANGIO ABD AND PELVIS","code_information":[{"code":"3574174","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":7314.25,"setting":"both","billing_class":"facility"},{"gross_charge":5566.5,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO ABD","code_information":[{"code":"3574175","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":5293.25,"setting":"both","billing_class":"facility"},{"gross_charge":4028.25,"setting":"both","billing_class":"professional"}]},{"description":"CT ANGIO ABD AORTA W RUNOFF","code_information":[{"code":"3575635","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6609.0,"setting":"both","billing_class":"facility"},{"gross_charge":5030.0,"setting":"both","billing_class":"professional"}]},{"description":"SURGERY LEVEL I 0-30 MINS","code_information":[{"code":"3600008","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4530.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL I EA ADDL 15M","code_information":[{"code":"3600009","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2265.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL II EA ADL 15M","code_information":[{"code":"3600011","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2457.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL III EA ADDL 15M","code_information":[{"code":"3600012","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2659.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL IV 0-30 MINS","code_information":[{"code":"3600013","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5682.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL IV EA ADDL 15M","code_information":[{"code":"3600014","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2841.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL V 0-30 MINS","code_information":[{"code":"3600015","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6066.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL V EA ADDL 15M","code_information":[{"code":"3600016","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3033.25,"setting":"both","billing_class":"facility"}]},{"description":"SURG EMERG/UNSCHED PER 30M","code_information":[{"code":"3600017","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":383.25,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY SET UP CHARGE","code_information":[{"code":"3600018","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":384.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL II 0-30 MINS","code_information":[{"code":"3600027","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4914.5,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY LEVEL III 0-30 MINS","code_information":[{"code":"3600028","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5317.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY OB LEVEL II 0-30 MINS","code_information":[{"code":"3600032","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4914.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY OB LEVEL II EA ADL 15M","code_information":[{"code":"3600033","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2457.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY OB LEVEL IV 0-30 MINS","code_information":[{"code":"3600036","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5682.75,"setting":"both","billing_class":"facility"}]},{"description":"SURGERY OB LEVEL IV ADDL 15M","code_information":[{"code":"3600037","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2841.75,"setting":"both","billing_class":"facility"}]},{"description":"SURG OB EMERG/UNSCHED PER 30M","code_information":[{"code":"3600040","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":383.25,"setting":"both","billing_class":"facility"}]},{"description":"OR USAGE CHARGE","code_information":[{"code":"3600041","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":323.25,"setting":"both","billing_class":"facility"},{"gross_charge":229.25,"setting":"both","billing_class":"professional"}]},{"description":"SURGERY OB SET UP CHARGE","code_information":[{"code":"3600042","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":384.5,"setting":"both","billing_class":"facility"}]},{"description":"SURG OB EXTRA PERSON PER 30M","code_information":[{"code":"3600043","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL I 0-30 MINS","code_information":[{"code":"3600044","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4896.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL II 0-30 MINS","code_information":[{"code":"3600045","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5280.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL III 0-30 MINS","code_information":[{"code":"3600046","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5668.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL IV 0-30 MINS","code_information":[{"code":"3600047","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6048.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL V 0-30 MINS","code_information":[{"code":"3600048","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6432.0,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL I EA ADDL 15M","code_information":[{"code":"3600049","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2448.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL II EA ADDL 15M","code_information":[{"code":"3600050","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2640.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL III EA ADL 15M","code_information":[{"code":"3600051","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2834.5,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL IV EA ADDL 15M","code_information":[{"code":"3600052","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3024.5,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG LEVEL V EA ADDL 15M","code_information":[{"code":"3600053","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3216.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG OB LEVEL IV 0-30 MIN","code_information":[{"code":"3600060","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6048.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER SURG OB LEVEL IV ADDL 15M","code_information":[{"code":"3600061","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3024.5,"setting":"both","billing_class":"facility"}]},{"description":"LAPROSCOPIC PROCEDURE","code_information":[{"code":"3600090","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1748.0,"setting":"both","billing_class":"facility"},{"gross_charge":1243.0,"setting":"both","billing_class":"professional"}]},{"description":"POST OP EXTENDED RECOVERY","code_information":[{"code":"3600325","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":3064.5,"setting":"both","billing_class":"facility"}]},{"description":"PRE OP PREP & ASSESSMENT","code_information":[{"code":"3600351","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":770.5,"setting":"both","billing_class":"facility"},{"gross_charge":547.5,"setting":"both","billing_class":"professional"}]},{"description":"PRE OP ASSESSMENT","code_information":[{"code":"3600352","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":149.5,"setting":"both","billing_class":"facility"},{"gross_charge":105.75,"setting":"both","billing_class":"professional"}]},{"description":"PACU II/RECOVERY","code_information":[{"code":"3600354","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":2972.25,"setting":"both","billing_class":"facility"}]},{"description":"ORGAN/TISSUE PROCURE OR","code_information":[{"code":"3600400","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":808.25,"setting":"both","billing_class":"facility"},{"gross_charge":574.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT ARTERIAL LINE","code_information":[{"code":"3600501","type":"CDM"},{"code":"361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"facility"},{"gross_charge":256.5,"setting":"both","billing_class":"professional"}]},{"description":"ER ARTERIAL LINE INSERT","code_information":[{"code":"3600502","type":"CDM"},{"code":"450","type":"RC"},{"code":"36100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.75,"setting":"both","billing_class":"facility"},{"gross_charge":1741.5,"setting":"both","billing_class":"professional"}]},{"description":"LARYNGOSCOPY DIAGNOSTIC","code_information":[{"code":"3600504","type":"CDM"},{"code":"361","type":"RC"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.75,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHOSCOPY AT BEDSIDE","code_information":[{"code":"3600506","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":2869.5,"setting":"both","billing_class":"facility"}]},{"description":"DEB MUSC/FASCIA 20 SQ CM/<","code_information":[{"code":"3600507","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.75,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-SDS","code_information":[{"code":"3600511","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-2N","code_information":[{"code":"3600512","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-3S","code_information":[{"code":"3600513","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-4S","code_information":[{"code":"3600514","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-ICU","code_information":[{"code":"3600515","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-LTC","code_information":[{"code":"3600516","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-NUR","code_information":[{"code":"3600517","type":"CDM"},{"code":"361","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-OB/3N","code_information":[{"code":"3600518","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LINE INSERT-PCU","code_information":[{"code":"3600519","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEST TUBE INSERT","code_information":[{"code":"3600522","type":"CDM"},{"code":"361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2619.0,"setting":"both","billing_class":"facility"}]},{"description":"SWAN GANZ (PA CATH) INSERT","code_information":[{"code":"3600541","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1482.75,"setting":"both","billing_class":"facility"},{"gross_charge":1054.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT O2 THERMO CATH","code_information":[{"code":"3600542","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1629.0,"setting":"both","billing_class":"facility"},{"gross_charge":1158.25,"setting":"both","billing_class":"professional"}]},{"description":"INTUBATION-2N","code_information":[{"code":"3600552","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"},{"gross_charge":1295.75,"setting":"both","billing_class":"professional"}]},{"description":"INTUBATION-3S","code_information":[{"code":"3600553","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-ICU","code_information":[{"code":"3600554","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-PCU","code_information":[{"code":"3600555","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-NUR","code_information":[{"code":"3600556","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-4S","code_information":[{"code":"3600557","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-LTC","code_information":[{"code":"3600558","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION-OB/3N","code_information":[{"code":"3600559","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"INSERT/RPLC TEMP TRANSVNS CATH","code_information":[{"code":"3600561","type":"CDM"},{"code":"361","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":13052.0,"setting":"both","billing_class":"facility"},{"gross_charge":9934.0,"setting":"both","billing_class":"professional"}]},{"description":"THERAPEUTIC SPINAL PNXR DRAIN","code_information":[{"code":"3600570","type":"CDM"},{"code":"361","type":"RC"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL PUNCTURE LUMBAR DX","code_information":[{"code":"3600571","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL PUNCTURE LUMBAR DX W/IM","code_information":[{"code":"3600572","type":"CDM"},{"code":"361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL PUNCTURE LUMBAR DX-4S","code_information":[{"code":"3600573","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"PARACENTESIS","code_information":[{"code":"3600701","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":931.5,"setting":"both","billing_class":"facility"}]},{"description":"DIALYSIS CATH INSERT","code_information":[{"code":"3600732","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-2N","code_information":[{"code":"3600741","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-3S","code_information":[{"code":"3600742","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-4S","code_information":[{"code":"3600743","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-ICU","code_information":[{"code":"3600744","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-LTC","code_information":[{"code":"3600745","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-NUR","code_information":[{"code":"3600746","type":"CDM"},{"code":"361","type":"RC"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-OB/3N","code_information":[{"code":"3600747","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-PCU","code_information":[{"code":"3600748","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"PICC LINE INSERT-SDS","code_information":[{"code":"3600749","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"THORACENTESIS","code_information":[{"code":"3600751","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1451.5,"setting":"both","billing_class":"facility"}]},{"description":"MINOR PROC LEVEL I","code_information":[{"code":"3600800","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3502.75,"setting":"both","billing_class":"facility"},{"gross_charge":2491.0,"setting":"both","billing_class":"professional"}]},{"description":"MINOR PROC LEVEL II","code_information":[{"code":"3600801","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3968.75,"setting":"both","billing_class":"facility"},{"gross_charge":2823.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT STRAIGHT BLAD CATH","code_information":[{"code":"3600806","type":"CDM"},{"code":"361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.25,"setting":"both","billing_class":"facility"},{"gross_charge":216.5,"setting":"both","billing_class":"professional"}]},{"description":"CATH FOR COLLECTION OF SPEC AC","code_information":[{"code":"3600814","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":35.5,"setting":"both","billing_class":"professional"}]},{"description":"CATH FOR COLLECTION OF SPEC AC","code_information":[{"code":"3600814","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.75,"setting":"both","billing_class":"facility"}]},{"description":"MAJOR SURG ADDITIONAL PROC","code_information":[{"code":"3601303","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5514.25,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN/INJ MAJ JNT BURSA W/O US","code_information":[{"code":"3602061","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.25,"setting":"both","billing_class":"facility"}]},{"description":"EPIDURAL BL OR CLOT PATCH","code_information":[{"code":"3602273","type":"CDM"},{"code":"361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"},{"gross_charge":1452.75,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN FINGER ABSCESS SIMPLE","code_information":[{"code":"3602601","type":"CDM"},{"code":"361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.75,"setting":"both","billing_class":"facility"}]},{"description":"RPLC GTUBE NO REVJ TRC","code_information":[{"code":"3603762","type":"CDM"},{"code":"361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.5,"setting":"both","billing_class":"facility"}]},{"description":"NB INTERCOSTAL SINGLE","code_information":[{"code":"3604420","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"},{"gross_charge":1452.75,"setting":"both","billing_class":"professional"}]},{"description":"DX BRONCHOSCOPE/WASH","code_information":[{"code":"3605001","type":"CDM"},{"code":"360","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3679.0,"setting":"both","billing_class":"facility"}]},{"description":"DX BRONCHOSCOPE/LAVAGE","code_information":[{"code":"3605002","type":"CDM"},{"code":"360","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3679.0,"setting":"both","billing_class":"facility"}]},{"description":"BX THYROID PERC NEEDLE","code_information":[{"code":"3606010","type":"CDM"},{"code":"361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2510.0,"setting":"both","billing_class":"facility"},{"gross_charge":1909.75,"setting":"both","billing_class":"professional"}]},{"description":"WOUND CARE W/O ANES VAC<50","code_information":[{"code":"3607605","type":"CDM"},{"code":"361","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"},{"gross_charge":209.75,"setting":"both","billing_class":"professional"}]},{"description":"CANCELLED PROC MED/IV GIV","code_information":[{"code":"3609001","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":149.5,"setting":"both","billing_class":"facility"},{"gross_charge":105.75,"setting":"both","billing_class":"professional"}]},{"description":"PLACEMENT DEVICE/MARKER-OR","code_information":[{"code":"3609728","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.75,"setting":"both","billing_class":"facility"}]},{"description":"FNA BX W/US GUIDE 1ST LES","code_information":[{"code":"3610005","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.0,"setting":"both","billing_class":"facility"}]},{"description":"FNA BX W/US GUIDE ADDL LES","code_information":[{"code":"3610006","type":"CDM"},{"code":"361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.75,"setting":"both","billing_class":"facility"},{"gross_charge":70.25,"setting":"both","billing_class":"professional"}]},{"description":"BX OF SALIVARY GLAND-RAD","code_information":[{"code":"3610007","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.25,"setting":"both","billing_class":"facility"}]},{"description":"UNLISTED MUSCSKEL GEN PROC","code_information":[{"code":"3610008","type":"CDM"},{"code":"361","type":"RC"},{"code":"20999","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.25,"setting":"both","billing_class":"facility"}]},{"description":"FNA BX W/CT GUIDE 1ST LES","code_information":[{"code":"3610009","type":"CDM"},{"code":"361","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.0,"setting":"both","billing_class":"facility"},{"gross_charge":1347.25,"setting":"both","billing_class":"professional"}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"3610010","type":"CDM"},{"code":"361","type":"RC"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":8384.75,"setting":"both","billing_class":"facility"}]},{"description":"DRAINAGE OF KIDNEY LESION","code_information":[{"code":"3610011","type":"CDM"},{"code":"361","type":"RC"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.5,"setting":"both","billing_class":"facility"}]},{"description":"FNA BX W/CT GUIDE ADDL LES","code_information":[{"code":"3610012","type":"CDM"},{"code":"361","type":"RC"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"setting":"both","billing_class":"facility"},{"gross_charge":117.25,"setting":"both","billing_class":"professional"}]},{"description":"DRAIN/INJ MAJ JNT BURSA-RAD","code_information":[{"code":"3610020","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.25,"setting":"both","billing_class":"facility"}]},{"description":"YAG LASER AFTER CATERACT","code_information":[{"code":"3610030","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1856.0,"setting":"both","billing_class":"facility"},{"gross_charge":1319.75,"setting":"both","billing_class":"professional"}]},{"description":"CHANGE NEPH/PYELOSTOMY TUBE","code_information":[{"code":"3610040","type":"CDM"},{"code":"361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2694.25,"setting":"both","billing_class":"facility"},{"gross_charge":2050.0,"setting":"both","billing_class":"professional"}]},{"description":"INCISION & DRAINAGE SIMPLE","code_information":[{"code":"3610060","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.25,"setting":"both","billing_class":"facility"}]},{"description":"INCISION & DRAINAGE SIMPLE-3S","code_information":[{"code":"3610061","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.25,"setting":"both","billing_class":"facility"}]},{"description":"I&D ABSCESS COMP/MULTIPLE","code_information":[{"code":"3610062","type":"CDM"},{"code":"360","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.5,"setting":"both","billing_class":"facility"}]},{"description":"SINUS TRACT/FISTULAGRAM INJ","code_information":[{"code":"3610068","type":"CDM"},{"code":"361","type":"RC"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.5,"setting":"both","billing_class":"facility"},{"gross_charge":522.0,"setting":"both","billing_class":"professional"}]},{"description":"ASPIRATION/INJ THYROID CYST-RA","code_information":[{"code":"3610078","type":"CDM"},{"code":"361","type":"RC"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.25,"setting":"both","billing_class":"facility"},{"gross_charge":647.5,"setting":"both","billing_class":"professional"}]},{"description":"ANKLE ARTHROGRAM INJ","code_information":[{"code":"3610100","type":"CDM"},{"code":"361","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.25,"setting":"both","billing_class":"facility"},{"gross_charge":605.75,"setting":"both","billing_class":"professional"}]},{"description":"ELBOW ARTHROGRAM INJ","code_information":[{"code":"3610110","type":"CDM"},{"code":"361","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"setting":"both","billing_class":"facility"},{"gross_charge":591.75,"setting":"both","billing_class":"professional"}]},{"description":"HIP ARTHROGRAM INJ","code_information":[{"code":"3610120","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"setting":"both","billing_class":"facility"},{"gross_charge":686.0,"setting":"both","billing_class":"professional"}]},{"description":"KNEE ARTHROGRAM INJ","code_information":[{"code":"3610130","type":"CDM"},{"code":"361","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.5,"setting":"both","billing_class":"facility"},{"gross_charge":572.25,"setting":"both","billing_class":"professional"}]},{"description":"SHOULDER ARTHROGRAM INJ","code_information":[{"code":"3610140","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.25,"setting":"both","billing_class":"facility"},{"gross_charge":680.75,"setting":"both","billing_class":"professional"}]},{"description":"WRIST ARTHROGRAM INJ","code_information":[{"code":"3610150","type":"CDM"},{"code":"361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.5,"setting":"both","billing_class":"facility"},{"gross_charge":598.0,"setting":"both","billing_class":"professional"}]},{"description":"PUNCTURE ASPIRATION OF ABSC","code_information":[{"code":"3610160","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.75,"setting":"both","billing_class":"facility"},{"gross_charge":400.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ PROC CYSTOG/VOID URETHRO","code_information":[{"code":"3610170","type":"CDM"},{"code":"361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.5,"setting":"both","billing_class":"facility"},{"gross_charge":1144.75,"setting":"both","billing_class":"professional"}]},{"description":"INJ PROC HYSTEROSALP","code_information":[{"code":"3610190","type":"CDM"},{"code":"361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.5,"setting":"both","billing_class":"facility"},{"gross_charge":522.0,"setting":"both","billing_class":"professional"}]},{"description":"MAMM DUCTO/GALACTOGRAM INJ","code_information":[{"code":"3610200","type":"CDM"},{"code":"361","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.75,"setting":"both","billing_class":"facility"},{"gross_charge":634.75,"setting":"both","billing_class":"professional"}]},{"description":"NEPHROSTOGR/URETROGR INJ PX","code_information":[{"code":"3610201","type":"CDM"},{"code":"320","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.5,"setting":"both","billing_class":"facility"},{"gross_charge":755.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ PX NEPH/URETEROGR NEW ACES","code_information":[{"code":"3610202","type":"CDM"},{"code":"361","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.5,"setting":"both","billing_class":"facility"},{"gross_charge":755.5,"setting":"both","billing_class":"professional"}]},{"description":"INJ PROC LYMPHANGIOGRAPHY","code_information":[{"code":"3610210","type":"CDM"},{"code":"490","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.5,"setting":"both","billing_class":"facility"},{"gross_charge":656.0,"setting":"both","billing_class":"professional"}]},{"description":"INSERT BLADDER CATH FOLEY-2N","code_information":[{"code":"3610220","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"INSERT BLADDER CATH FOLEY-3S","code_information":[{"code":"3610221","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"INSERT BLADDER CATH FOLEY-ICU","code_information":[{"code":"3610223","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"INSERT BLADDER CATH FOLEY-PCU","code_information":[{"code":"3610224","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN SNGL LES-2N","code_information":[{"code":"3610240","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.5,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN SNGL LES-3S","code_information":[{"code":"3610241","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.5,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN EA ADDL-2N","code_information":[{"code":"3610250","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.25,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN EA ADDL-3S","code_information":[{"code":"3610251","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.25,"setting":"both","billing_class":"facility"}]},{"description":"DEBRIDE NAIL 1-5-2N","code_information":[{"code":"3610262","type":"CDM"},{"code":"361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ PROC SIALOG","code_information":[{"code":"3610280","type":"CDM"},{"code":"361","type":"RC"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.75,"setting":"both","billing_class":"facility"},{"gross_charge":504.0,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL OF NEPH TUBE W FLOU","code_information":[{"code":"3610301","type":"CDM"},{"code":"361","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":1454.25,"setting":"both","billing_class":"facility"},{"gross_charge":1106.5,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAPHY LUMBAR INJ;CERVICA","code_information":[{"code":"3610302","type":"CDM"},{"code":"361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":6445.0,"setting":"both","billing_class":"facility"},{"gross_charge":4905.0,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAPHY LUMBAR INJ;THORACI","code_information":[{"code":"3610303","type":"CDM"},{"code":"361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":6445.0,"setting":"both","billing_class":"facility"},{"gross_charge":4905.0,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAPHY LUMBAR INJ;LUMBOSA","code_information":[{"code":"3610304","type":"CDM"},{"code":"361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":6445.0,"setting":"both","billing_class":"facility"},{"gross_charge":4905.0,"setting":"both","billing_class":"professional"}]},{"description":"MYELOGRAPHY LUMBAR INJ;2orMORE","code_information":[{"code":"3610305","type":"CDM"},{"code":"361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":6445.0,"setting":"both","billing_class":"facility"},{"gross_charge":4905.0,"setting":"both","billing_class":"professional"}]},{"description":"PERCUTANEOUS CHOLECYSTOSTOMY","code_information":[{"code":"3610465","type":"CDM"},{"code":"320","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.5,"setting":"both","billing_class":"facility"},{"gross_charge":3916.0,"setting":"both","billing_class":"professional"}]},{"description":"FNA W/O RAD GUIDANCE","code_information":[{"code":"3610609","type":"CDM"},{"code":"361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.5,"setting":"both","billing_class":"facility"},{"gross_charge":431.5,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST STEREO RT","code_information":[{"code":"3610646","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.75,"setting":"both","billing_class":"professional"},{"gross_charge":2101.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"BX BREAST STEREO LT","code_information":[{"code":"3610647","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.75,"setting":"both","billing_class":"professional"},{"gross_charge":2101.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"BX BREAST STEREO ADD","code_information":[{"code":"3610648","type":"CDM"},{"code":"361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.75,"setting":"both","billing_class":"facility"},{"gross_charge":110.5,"setting":"both","billing_class":"professional"}]},{"description":"DRAINAGE ABSC OF MOUTH","code_information":[{"code":"3610800","type":"CDM"},{"code":"361","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.75,"setting":"both","billing_class":"facility"}]},{"description":"PLCMNT DEV SOFT TISS 1ST LES","code_information":[{"code":"3610807","type":"CDM"},{"code":"361","type":"RC"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.25,"setting":"both","billing_class":"facility"}]},{"description":"BREAST DEVICE PLACEMNT W/US LT","code_information":[{"code":"3610808","type":"CDM"},{"code":"361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.75,"setting":"both","billing_class":"professional"},{"gross_charge":969.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"BREAST DEVICE PLACEMNT W/US RT","code_information":[{"code":"3610809","type":"CDM"},{"code":"361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.75,"setting":"both","billing_class":"professional"},{"gross_charge":969.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"PERQ DEV BREAST 1ST STRTCTC LT","code_information":[{"code":"3610810","type":"CDM"},{"code":"361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":808.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"PERQ DEV BREAST 1ST STRTCTC RT","code_information":[{"code":"3610811","type":"CDM"},{"code":"361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":808.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"PERQ DEV BREAST ADD STRTCTC","code_information":[{"code":"3610812","type":"CDM"},{"code":"361","type":"RC"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"setting":"both","billing_class":"facility"},{"gross_charge":389.75,"setting":"both","billing_class":"professional"}]},{"description":"BX BREAST US RT","code_information":[{"code":"3610820","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.75,"setting":"both","billing_class":"professional"},{"gross_charge":2102.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"BX BREAST US LT","code_information":[{"code":"3610821","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.75,"setting":"both","billing_class":"professional"},{"gross_charge":2102.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"BX BREAST US ADD","code_information":[{"code":"3610822","type":"CDM"},{"code":"361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility"},{"gross_charge":111.25,"setting":"both","billing_class":"professional"}]},{"description":"BREAST DEVICE PLACEMENT ADD","code_information":[{"code":"3610825","type":"CDM"},{"code":"361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":80.25,"setting":"both","billing_class":"professional"}]},{"description":"BREAST DEVICE PLCMNT W/MAMM RT","code_information":[{"code":"3610826","type":"CDM"},{"code":"361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.75,"setting":"both","billing_class":"professional"},{"gross_charge":969.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"BREAST DEVICE PLCMNT W/MAMM LT","code_information":[{"code":"3610827","type":"CDM"},{"code":"361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.75,"setting":"both","billing_class":"professional"},{"gross_charge":969.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MAMM NEEDLE PLACEMENT ADD","code_information":[{"code":"3610828","type":"CDM"},{"code":"361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.25,"setting":"both","billing_class":"facility"},{"gross_charge":80.25,"setting":"both","billing_class":"professional"}]},{"description":"MRI BREAST BIOPSY RT","code_information":[{"code":"3610830","type":"CDM"},{"code":"361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.75,"setting":"both","billing_class":"professional"},{"gross_charge":1834.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI BREAST BIOPSY LT","code_information":[{"code":"3610831","type":"CDM"},{"code":"361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.75,"setting":"both","billing_class":"professional"},{"gross_charge":1834.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI BREAST BIOPSY ADD","code_information":[{"code":"3610832","type":"CDM"},{"code":"361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.5,"setting":"both","billing_class":"facility"},{"gross_charge":118.75,"setting":"both","billing_class":"professional"}]},{"description":"MRI DEVICE PLACEMENT RT","code_information":[{"code":"3610833","type":"CDM"},{"code":"361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.5,"setting":"both","billing_class":"professional"},{"gross_charge":889.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI DEVICE PLACEMENT LT","code_information":[{"code":"3610834","type":"CDM"},{"code":"361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.5,"setting":"both","billing_class":"professional"},{"gross_charge":889.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI NEEDLE PLACEMENT ADD","code_information":[{"code":"3610835","type":"CDM"},{"code":"361","type":"RC"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.25,"setting":"both","billing_class":"facility"},{"gross_charge":69.75,"setting":"both","billing_class":"professional"}]},{"description":"DBRDMT SUBQ TIS 1ST 20SQCM/<","code_information":[{"code":"3611042","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.5,"setting":"both","billing_class":"facility"}]},{"description":"PERC BX BREAST LESIONS STERO","code_information":[{"code":"3611100","type":"CDM"},{"code":"490","type":"RC"},{"code":"C7501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.75,"setting":"both","billing_class":"facility"}]},{"description":"PERC BX BREAST LESIONS MR","code_information":[{"code":"3611101","type":"CDM"},{"code":"490","type":"RC"},{"code":"C7502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.75,"setting":"both","billing_class":"facility"}]},{"description":"BIOPSY LYMPH NODES PERC","code_information":[{"code":"3618505","type":"CDM"},{"code":"361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.5,"setting":"both","billing_class":"facility"},{"gross_charge":1598.25,"setting":"both","billing_class":"professional"}]},{"description":"INTRAOPERATIVE MAPPING","code_information":[{"code":"3618900","type":"CDM"},{"code":"361","type":"RC"},{"code":"38900","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"setting":"both","billing_class":"facility"},{"gross_charge":478.25,"setting":"both","billing_class":"professional"}]},{"description":"PARACENTESIS-RAD","code_information":[{"code":"3619083","type":"CDM"},{"code":"361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.5,"setting":"both","billing_class":"facility"}]},{"description":"PERCUTANEOUS MUSCLE BX","code_information":[{"code":"3620206","type":"CDM"},{"code":"361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2101.25,"setting":"both","billing_class":"facility"},{"gross_charge":1598.75,"setting":"both","billing_class":"professional"}]},{"description":"REMOVAL FOREIGN BODY","code_information":[{"code":"3627372","type":"CDM"},{"code":"361","type":"RC"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":3383.5,"setting":"both","billing_class":"facility"},{"gross_charge":2574.75,"setting":"both","billing_class":"professional"}]},{"description":"INSERT CATH W/IMAGE","code_information":[{"code":"3632557","type":"CDM"},{"code":"361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"setting":"both","billing_class":"facility"}]},{"description":"REPLACE PICC CATH","code_information":[{"code":"3636584","type":"CDM"},{"code":"361","type":"RC"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.75,"setting":"both","billing_class":"facility"}]},{"description":"BLADDER INSTIL ANTICARCIN","code_information":[{"code":"3651720","type":"CDM"},{"code":"361","type":"RC"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.75,"setting":"both","billing_class":"facility"}]},{"description":"WOUND CARE NEG PRESS >50CM","code_information":[{"code":"3697606","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.75,"setting":"both","billing_class":"facility"}]},{"description":"MODERATE SEDATION 15M ENDO","code_information":[{"code":"3700100","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"}]},{"description":"ANES ENDO MAC 0-30MINS","code_information":[{"code":"3700101","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":449.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES ENDO MAC ADDL 15M","code_information":[{"code":"3700102","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":222.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES ENDO GEN 0-30 MINS","code_information":[{"code":"3700103","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":653.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES ENDO GEN ADDL 15","code_information":[{"code":"3700104","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":327.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES OB 0-30MIN","code_information":[{"code":"3700200","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":294.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES 0-30 MINS","code_information":[{"code":"3700201","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":448.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES ADDL 15 MINS","code_information":[{"code":"3700202","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":152.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES OB 31-60 MIN","code_information":[{"code":"3700230","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES OB 61-90 MIN","code_information":[{"code":"3700240","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":332.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES OB 91-120 MIN","code_information":[{"code":"3700250","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":348.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES SUPPLIES OB 121 & >MIN","code_information":[{"code":"3700260","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":437.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB GENERAL 0-30MINS","code_information":[{"code":"3700270","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":653.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB GENERAL ADDL 15MINS","code_information":[{"code":"3700271","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":327.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB SPINAL/EPIDURAL OCC","code_information":[{"code":"3700272","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":576.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB REGIONAL BLOCK OCC","code_information":[{"code":"3700273","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":448.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB GAS PER 30 MINS","code_information":[{"code":"3700274","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB MAC 0-30MINS","code_information":[{"code":"3700275","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":448.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES OB MAC ADDL 15 MINS","code_information":[{"code":"3700276","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES GENERAL 0-30 MINS","code_information":[{"code":"3700300","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":653.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES GENERAL EA ADDL 15M","code_information":[{"code":"3700301","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":327.0,"setting":"both","billing_class":"facility"}]},{"description":"ANES MAC 0-30 MINS","code_information":[{"code":"3700302","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":449.25,"setting":"both","billing_class":"facility"}]},{"description":"ANES MAC EA ADDL 15 MINS","code_information":[{"code":"3700303","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":224.75,"setting":"both","billing_class":"facility"}]},{"description":"ANES SPINAL/EPIDURAL PER OCC","code_information":[{"code":"3700304","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":576.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES REGIONAL BLOCK PER OCC","code_information":[{"code":"3700305","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":448.5,"setting":"both","billing_class":"facility"}]},{"description":"MODERATE SEDATION 15M SURG","code_information":[{"code":"3700306","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":255.75,"setting":"both","billing_class":"facility"}]},{"description":"LOCAL NURSE MONITORING SUR","code_information":[{"code":"3700307","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":192.5,"setting":"both","billing_class":"facility"}]},{"description":"ANESTHESIA GAS PER 30 MINS","code_information":[{"code":"3700308","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":96.25,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL/EPIDURAL ANES","code_information":[{"code":"3700511","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":268.5,"setting":"both","billing_class":"facility"}]},{"description":"ANESTHESIA FOR MRI","code_information":[{"code":"3700600","type":"CDM"},{"code":"370","type":"RC"},{"code":"01922","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.25,"setting":"both","billing_class":"facility"}]},{"description":"CRYOPRECIPITATE POOL 5 UNITS","code_information":[{"code":"3800041","type":"CDM"},{"code":"387","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"setting":"both","billing_class":"facility"}]},{"description":"FRESH FROZEN PLASMA PRODUCT","code_information":[{"code":"3800081","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"setting":"both","billing_class":"facility"}]},{"description":"FRESH FROZEN PLASMA THAWING","code_information":[{"code":"3800082","type":"CDM"},{"code":"305","type":"RC"},{"code":"86927","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"setting":"both","billing_class":"facility"}]},{"description":"PLATELETS, HLA-M, L/R, UNIT","code_information":[{"code":"3900075","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.75,"setting":"both","billing_class":"facility"},{"gross_charge":1961.0,"setting":"both","billing_class":"professional"}]},{"description":"PLATELETS PHERESIS LEUK REDU E","code_information":[{"code":"3900085","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2088.25,"setting":"both","billing_class":"facility"}]},{"description":"PLATELETS PHERESIS LEUK RED IR","code_information":[{"code":"3900087","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.75,"setting":"both","billing_class":"facility"}]},{"description":"RBC LEUKOCYTES REDUCED EACH UN","code_information":[{"code":"3900090","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.75,"setting":"both","billing_class":"facility"}]},{"description":"RBC LEUKOCYTES REDU IRRADIAT E","code_information":[{"code":"3900091","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-PCU","code_information":[{"code":"3910126","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-ICU","code_information":[{"code":"3910127","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-AC","code_information":[{"code":"3910128","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-2N","code_information":[{"code":"3910129","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-3S","code_information":[{"code":"3910130","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-3N/OB","code_information":[{"code":"3910131","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-INF","code_information":[{"code":"3910132","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TRANSFUSION-4S","code_information":[{"code":"3910133","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND THORACENTESIS","code_information":[{"code":"4000005","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.5,"setting":"both","billing_class":"facility"}]},{"description":"DUCTOGRAM MAMMARY-MULTI DUCTS","code_information":[{"code":"4000006","type":"CDM"},{"code":"320","type":"RC"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":2061.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND ABDOMINAL","code_information":[{"code":"4000010","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND ABD LIMITED","code_information":[{"code":"4000011","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND AMNIOCENTESIS","code_information":[{"code":"4000040","type":"CDM"},{"code":"402","type":"RC"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND AORTA LIMITED","code_information":[{"code":"4000050","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.5,"setting":"both","billing_class":"facility"}]},{"description":"DUCTOGRAM MAMMARY-SINGLE DUCT","code_information":[{"code":"4000054","type":"CDM"},{"code":"320","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND AB AORT AN(AAA)SCR","code_information":[{"code":"4000056","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.5,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN/INJ MAJOR JNT W/US RT","code_information":[{"code":"4000057","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"DRAIN/INJ MAJOR JNT W/US LT","code_information":[{"code":"4000058","type":"CDM"},{"code":"361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ULTRASOUND E PARENCHYMA","code_information":[{"code":"4000060","type":"CDM"},{"code":"402","type":"RC"},{"code":"76981","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.5,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND E 1ST TARG LESION","code_information":[{"code":"4000061","type":"CDM"},{"code":"402","type":"RC"},{"code":"76982","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.5,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND E ADD TARG LESION","code_information":[{"code":"4000062","type":"CDM"},{"code":"402","type":"RC"},{"code":"76983","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.5,"setting":"both","billing_class":"facility"},{"gross_charge":231.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASOUND BIOPH PROF W NONSTR","code_information":[{"code":"4000070","type":"CDM"},{"code":"402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":2943.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND BIOPH PROF WO NONST","code_information":[{"code":"4000071","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2231.25,"setting":"both","billing_class":"facility"}]},{"description":"DOPPLER UMBILICAL ARTERY","code_information":[{"code":"4000073","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2231.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND GUIDE FOR NEEDLE BX","code_information":[{"code":"4000086","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND GUIDANCE INTRAOPERT","code_information":[{"code":"4000089","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND LIMITED BLADDER","code_information":[{"code":"4000091","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SC EXT VEIN UNI","code_information":[{"code":"4000092","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DOPPLER CAROTID BIL","code_information":[{"code":"4000093","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DOPPLER CAROTID UNI","code_information":[{"code":"4000094","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SC EXT VEIN BIL","code_information":[{"code":"4000095","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND BREAST BIL LIMITED","code_information":[{"code":"4000101","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":2642.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"ULTRASOUND BRST UNI LIMITED LT","code_information":[{"code":"4000102","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ULTRASOUND BRST UNI LIMITED RT","code_information":[{"code":"4000103","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ULTRASOUND BREAST BIL COMPLETE","code_information":[{"code":"4000104","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":2539.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"ULTRASOUND BRST UNI COMPL LT","code_information":[{"code":"4000105","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ULTRASOUND BRST UNI COMPL RT","code_information":[{"code":"4000106","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"DUPLEX ARTERIAL FLOW; COMPL","code_information":[{"code":"4000122","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND PVR U/L EXT 2LEVEL","code_information":[{"code":"4000123","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND PVR U/L EXT 3LEVEL","code_information":[{"code":"4000124","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SCAN LWR EXT UN","code_information":[{"code":"4000125","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SCAN UP EXT UNI","code_information":[{"code":"4000126","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SCAN LWR EXT BI","code_information":[{"code":"4000127","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND DUP SCAN UP EXT BIL","code_information":[{"code":"4000128","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND ARTERIAL AORTA","code_information":[{"code":"4000129","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND CHEST","code_information":[{"code":"4000130","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1681.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND BX/ASPIRAT RENAL RT","code_information":[{"code":"4000200","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":3414.0,"setting":"both","modifiers":"RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ULTRASOUND BX/ASPIRAT RENAL LT","code_information":[{"code":"4000201","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":3414.0,"setting":"both","modifiers":"LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ULTRASOUND ECHOENCEPHO HEAD","code_information":[{"code":"4000205","type":"CDM"},{"code":"402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1820.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND EXTREMITIES-LIMITED","code_information":[{"code":"4000210","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND EXTREMITIES-COMPLET","code_information":[{"code":"4000211","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1512.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND GUIDANCE-VASC ACCES","code_information":[{"code":"4000251","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND HIPS INFANT LIMITED","code_information":[{"code":"4000253","type":"CDM"},{"code":"402","type":"RC"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB LIMITED","code_information":[{"code":"4000280","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB  FOLLOW UP/FETUS","code_information":[{"code":"4000281","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.5,"setting":"both","billing_class":"facility"}]},{"description":"US SALINE INFUSED SONOHYSTRGRP","code_information":[{"code":"4000282","type":"CDM"},{"code":"402","type":"RC"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB COMP < 14 WE","code_information":[{"code":"4000292","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB ADD'L GEST<14 WE","code_information":[{"code":"4000293","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB COMP >14 WE","code_information":[{"code":"4000296","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB ADD'L GEST>14 WE","code_information":[{"code":"4000297","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND COMPLETE-PELVIC","code_information":[{"code":"4000320","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND RETROPERITONEAL","code_information":[{"code":"4000350","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND SPINAL CANAL INFANT","code_information":[{"code":"4000402","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.25,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND TESTICULAR/SCROTUM","code_information":[{"code":"4000410","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2572.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND SOFT TISSUE HEAD/NE","code_information":[{"code":"4000430","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND TRANSRECTAL/PROSTA","code_information":[{"code":"4000450","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1925.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND NON-OB TRANSVAGINAL","code_information":[{"code":"4000470","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.75,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND OB TRANSVAGINAL","code_information":[{"code":"4000471","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.5,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASND CATH FLUID COLXN VISC","code_information":[{"code":"4000500","type":"CDM"},{"code":"360","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3657.5,"setting":"both","billing_class":"facility"},{"gross_charge":3383.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASND CATH FLUID PERI/RETRO","code_information":[{"code":"4000501","type":"CDM"},{"code":"360","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3657.5,"setting":"both","billing_class":"facility"},{"gross_charge":3383.75,"setting":"both","billing_class":"professional"}]},{"description":"ULTRASND GUID CATH FLUID DRAIN","code_information":[{"code":"4000502","type":"CDM"},{"code":"360","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.25,"setting":"both","billing_class":"facility"},{"gross_charge":1464.5,"setting":"both","billing_class":"professional"}]},{"description":"US OB FOLLOW UP/FETUS (59)","code_information":[{"code":"4000923","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.5,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"US BIOPH PROF W/O NONST (59)","code_information":[{"code":"4000924","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2231.25,"setting":"both","modifiers":"59","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"TOMO BIL SCREEN","code_information":[{"code":"4010001","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","billing_class":"facility"},{"gross_charge":60.25,"setting":"both","billing_class":"professional"}]},{"description":"TOMO UNI SCREEN LT","code_information":[{"code":"4010003","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"TOMO UNI SCREEN RT","code_information":[{"code":"4010005","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"TOMO BIL DIAGNOSTIC","code_information":[{"code":"4010007","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","billing_class":"facility"}]},{"description":"TOMO UNI DIAG LT","code_information":[{"code":"4010009","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MAMM UNI DIAG LT","code_information":[{"code":"4010010","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MAMM UNI DIAG RT","code_information":[{"code":"4010012","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MAMM BIL DIAG","code_information":[{"code":"4010015","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.75,"setting":"both","billing_class":"facility"}]},{"description":"MAMM UNI SCREEN RT","code_information":[{"code":"4010028","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"MAMM UNI SCREEN LT","code_information":[{"code":"4010029","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"TOMO UNI DIAG RT","code_information":[{"code":"4010033","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TOMO DIAGNOSTIC W GG","code_information":[{"code":"4010035","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"TOMO UNI DIAG LT W GG","code_information":[{"code":"4010037","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"setting":"both","modifiers":"LT|GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"MAMM UNI DIAG RT W GG","code_information":[{"code":"4010039","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","modifiers":"RT|GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"MAMM BIL SCREEN","code_information":[{"code":"4010041","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.75,"setting":"both","billing_class":"facility"}]},{"description":"MAMM UNI DIAG LT W GG","code_information":[{"code":"4010043","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","modifiers":"LT|GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"MAMM BIL DIAG W GG MOD","code_information":[{"code":"4010044","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.75,"setting":"both","modifiers":"GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"TOMO UNI DIAG RT W GG","code_information":[{"code":"4010057","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.25,"setting":"both","modifiers":"RT|GG","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day"}]},{"description":"PET IMAGE-BRAIN IMAGING","code_information":[{"code":"4040100","type":"CDM"},{"code":"404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":9149.25,"setting":"both","billing_class":"facility"}]},{"description":"PET HEART MUSCLE IMAGE","code_information":[{"code":"4040110","type":"CDM"},{"code":"404","type":"RC"},{"code":"78459","type":"HCPCS"}],"standard_charges":[{"gross_charge":7499.25,"setting":"both","billing_class":"facility"}]},{"description":"PET IMAGE-HEART IMAGE MULTIPLE","code_information":[{"code":"4040115","type":"CDM"},{"code":"404","type":"RC"},{"code":"78492","type":"HCPCS"}],"standard_charges":[{"gross_charge":5850.0,"setting":"both","billing_class":"facility"}]},{"description":"PET IMAGE-HEART IMAGE SINGLE","code_information":[{"code":"4040116","type":"CDM"},{"code":"404","type":"RC"},{"code":"78491","type":"HCPCS"}],"standard_charges":[{"gross_charge":5850.0,"setting":"both","billing_class":"facility"}]},{"description":"PET/CT IMAGING SKULL-THIGH","code_information":[{"code":"4040126","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":9297.0,"setting":"both","billing_class":"facility"}]},{"description":"PET/CT IMAGING FULL BODY","code_information":[{"code":"4040127","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":9628.25,"setting":"both","billing_class":"facility"}]},{"description":"PET W/CT LMTD CHEST, HEAD/NECK","code_information":[{"code":"4040129","type":"CDM"},{"code":"404","type":"RC"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":3632.5,"setting":"both","billing_class":"facility"},{"gross_charge":3360.75,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 1 VISIT EST-CARDIO","code_information":[{"code":"4100015","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.5,"setting":"both","billing_class":"facility"}]},{"description":"AEROCHAMBER INHALER","code_information":[{"code":"4100250","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":66.75,"setting":"both","billing_class":"facility"}]},{"description":"COLLECTION SPUTUM SPECIMEN","code_information":[{"code":"4100350","type":"CDM"},{"code":"300","type":"RC"},{"code":"89220","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.5,"setting":"both","billing_class":"facility"}]},{"description":"BACTERIA FILTER","code_information":[{"code":"4100400","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":50.75,"setting":"both","billing_class":"facility"}]},{"description":"BIPAP INITIAL & MANAGEMENT","code_information":[{"code":"4100415","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.75,"setting":"both","billing_class":"facility"}]},{"description":"CONT POSTIVE AIRWAY PRESSURE","code_information":[{"code":"4100435","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":48.75,"setting":"both","billing_class":"facility"}]},{"description":"CONTINUOUS AEROSOL SET UP","code_information":[{"code":"4100450","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"}]},{"description":"AEROSOL MASK","code_information":[{"code":"4100451","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"}]},{"description":"CONTINUOUS PULSE OX-EQUIP","code_information":[{"code":"4100460","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.25,"setting":"both","billing_class":"facility"}]},{"description":"EQUIP-OXIMETRY SPOT CHECK","code_information":[{"code":"4100470","type":"CDM"},{"code":"410","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"facility"}]},{"description":"INCENTIVE SPIROMETRY-DISP SUP","code_information":[{"code":"4100510","type":"CDM"},{"code":"270","type":"RC"},{"code":"A9284","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.5,"setting":"both","billing_class":"facility"}]},{"description":"POSITIVE EXP PRESSURE DEVICE","code_information":[{"code":"4100521","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":119.5,"setting":"both","billing_class":"facility"}]},{"description":"AIRWAY INHALATION TX","code_information":[{"code":"4100535","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN-NASAL AND MASK SET UP","code_information":[{"code":"4100541","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":207.5,"setting":"both","billing_class":"facility"}]},{"description":"REBREATHER MASKS","code_information":[{"code":"4100542","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":207.5,"setting":"both","billing_class":"facility"}]},{"description":"NASAL CANNULA","code_information":[{"code":"4100545","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":48.75,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN SETUP","code_information":[{"code":"4100560","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":247.25,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN CHARGE DAILY","code_information":[{"code":"4100582","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":207.5,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN-PORTABLE","code_information":[{"code":"4100600","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":56.25,"setting":"both","billing_class":"facility"}]},{"description":"MANIPULATION CHST WALL SUBSQ","code_information":[{"code":"4100630","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.75,"setting":"both","billing_class":"facility"}]},{"description":"RESUSCITATION","code_information":[{"code":"4100657","type":"CDM"},{"code":"410","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"setting":"both","billing_class":"facility"}]},{"description":"SMOKING CESSATION TEACHING","code_information":[{"code":"4100658","type":"CDM"},{"code":"942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.75,"setting":"both","billing_class":"facility"}]},{"description":"VENTILATOR - NOSE","code_information":[{"code":"4100740","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":20.75,"setting":"both","billing_class":"facility"},{"gross_charge":14.5,"setting":"both","billing_class":"professional"}]},{"description":"VENTILATOR SET-UP","code_information":[{"code":"4100750","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"setting":"both","billing_class":"facility"},{"gross_charge":1008.25,"setting":"both","billing_class":"professional"}]},{"description":"VENTILATOR PER SUBSEQUENT DAY","code_information":[{"code":"4100762","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.0,"setting":"both","billing_class":"facility"},{"gross_charge":1369.0,"setting":"both","billing_class":"professional"}]},{"description":"MANIPULATION CHST WALL INITIA","code_information":[{"code":"4101005","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"setting":"both","billing_class":"facility"},{"gross_charge":250.75,"setting":"both","billing_class":"professional"}]},{"description":"NITRIC OXIDE MEASUREMENT(NIOX)","code_information":[{"code":"4195012","type":"CDM"},{"code":"460","type":"RC"},{"code":"95012","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"setting":"both","billing_class":"facility"}]},{"description":"EVAL PT LOW COMPLEX","code_information":[{"code":"4200032","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"EVAL PT MODERATE COMPLEX","code_information":[{"code":"4200033","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"EVAL PT HIGH COMPLEX","code_information":[{"code":"4200034","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"REEVALUATION","code_information":[{"code":"4200036","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"ELECTRICAL STIM UNATT","code_information":[{"code":"4200091","type":"CDM"},{"code":"421","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"CANALITH REPOSITIONING","code_information":[{"code":"4200095","type":"CDM"},{"code":"421","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"GAIT/STAIRS TRAINING EA 15MIN","code_information":[{"code":"4200100","type":"CDM"},{"code":"421","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"GROUP THERAPEUTIC EXERCISE","code_information":[{"code":"4200251","type":"CDM"},{"code":"421","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"MANUAL THERAPY EA 15MIN","code_information":[{"code":"4200290","type":"CDM"},{"code":"421","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"MASSAGE EA 15MIN","code_information":[{"code":"4200310","type":"CDM"},{"code":"421","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"NEUROMUSCULA REED EA 15MIN","code_information":[{"code":"4200313","type":"CDM"},{"code":"421","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"ORTHOTICS FAB/FIT/TR EA 15MIN","code_information":[{"code":"4200317","type":"CDM"},{"code":"421","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"PHONOPHORESIS EA 15MIN","code_information":[{"code":"4200330","type":"CDM"},{"code":"421","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"PROSTHETIC TRAINING EA 15MIN","code_information":[{"code":"4200340","type":"CDM"},{"code":"421","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"THERAPEUTIC ACTIVITY EA 15MIN","code_information":[{"code":"4200364","type":"CDM"},{"code":"421","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"THERAPEUTIC EX/PROC EA 15MIN","code_information":[{"code":"4200369","type":"CDM"},{"code":"421","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"TRACTION MECHANICAL","code_information":[{"code":"4200371","type":"CDM"},{"code":"421","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"ULTRASOUND/E-STIM EA 15MIN","code_information":[{"code":"4200390","type":"CDM"},{"code":"421","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"WHEELCHAIR EVL/TRN PT 15MIN EA","code_information":[{"code":"4200485","type":"CDM"},{"code":"421","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"WOUND CARE W/MECH DEBR","code_information":[{"code":"4200492","type":"CDM"},{"code":"421","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"WOUND CARE W/S DEBR < 20CM","code_information":[{"code":"4200493","type":"CDM"},{"code":"421","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"WOUND CARE W/S DEBR > 20CM","code_information":[{"code":"4200494","type":"CDM"},{"code":"421","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"BIOFEED TRAINING 1ST 15MIN","code_information":[{"code":"4200912","type":"CDM"},{"code":"421","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"BIOFEED TRAINING EA ADDL 15M","code_information":[{"code":"4200913","type":"CDM"},{"code":"421","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"ACTIVITY OF DAILY LIV EA 15MIN","code_information":[{"code":"4202989","type":"CDM"},{"code":"421","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"AQUATIC/POOL THERAPY EA 15MIN","code_information":[{"code":"4202991","type":"CDM"},{"code":"421","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"FLUIDOTHERAPY","code_information":[{"code":"4203083","type":"CDM"},{"code":"421","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"IONTOPHRESIS EA 15MIN","code_information":[{"code":"4203130","type":"CDM"},{"code":"421","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"REINTEGRATION TRAINING EA 15M","code_information":[{"code":"4203180","type":"CDM"},{"code":"421","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"PRE EMPLOYMENT LIFT TEST","code_information":[{"code":"4203223","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":151.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"PRE EMPLOYMENT SCREEN DETAILED","code_information":[{"code":"4203224","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":304.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"PRE EMPLOYMENT SCREEN G L RR","code_information":[{"code":"4203227","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"WORK HARDENING FIRST 2HR","code_information":[{"code":"4203275","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.25,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HOT/COLD PACKS","code_information":[{"code":"4203530","type":"CDM"},{"code":"421","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"ELECTRICAL STIM ATT EA 15MIN","code_information":[{"code":"4203540","type":"CDM"},{"code":"421","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"PARAFFIN BATH","code_information":[{"code":"4203580","type":"CDM"},{"code":"421","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"WORK HARDENING ADD'L HR","code_information":[{"code":"4203615","type":"CDM"},{"code":"420","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"PHY THERAPY TRAINING/MONIT-HH","code_information":[{"code":"4203712","type":"CDM"},{"code":"421","type":"RC"}],"standard_charges":[{"gross_charge":4.5,"setting":"both","billing_class":"facility"}]},{"description":"SP PHYSICAL THERAPY EVAL","code_information":[{"code":"4203713","type":"CDM"},{"code":"990","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"SP PHYSICAL THERAPY TX/15MIN","code_information":[{"code":"4203714","type":"CDM"},{"code":"990","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.75,"setting":"both","billing_class":"facility"}]},{"description":"SENSORY INTEGRATION EA 15MIN","code_information":[{"code":"4300033","type":"CDM"},{"code":"431","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"ACTIVITY OF DAILY LIV EA 15MIN","code_information":[{"code":"4300201","type":"CDM"},{"code":"431","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.75,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"AQUATIC/POOL THERAPY EA 15MIN","code_information":[{"code":"4300211","type":"CDM"},{"code":"431","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"COGNITIVE TESTING 1ST 15M","code_information":[{"code":"4300401","type":"CDM"},{"code":"431","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"COGNITIVE TESTING EA ADDL 15M","code_information":[{"code":"4300402","type":"CDM"},{"code":"431","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"CONTRAST BATHS EA 15MIN","code_information":[{"code":"4300405","type":"CDM"},{"code":"431","type":"RC"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"ELECTRICAL STIM ATT EA 15MIN","code_information":[{"code":"4300526","type":"CDM"},{"code":"431","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"ELECTRICAL STIM UNATT","code_information":[{"code":"4300527","type":"CDM"},{"code":"431","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"FLUIDOTHERAPY","code_information":[{"code":"4300532","type":"CDM"},{"code":"431","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT LOW COMPLEX","code_information":[{"code":"4300546","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT MODERATE COMPLEX","code_information":[{"code":"4300547","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT HIGH COMPLEX","code_information":[{"code":"4300548","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"THERAPEUTIC ACTIVITY EA 15MIN","code_information":[{"code":"4300551","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"GROUP THERAPEUTIC EXER","code_information":[{"code":"4300555","type":"CDM"},{"code":"431","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HOT/COLD PACKS","code_information":[{"code":"4300601","type":"CDM"},{"code":"431","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"IONTOPHRESIS EA 15MIN","code_information":[{"code":"4300610","type":"CDM"},{"code":"431","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"MANUAL THERAPY EA 15MIN","code_information":[{"code":"4300620","type":"CDM"},{"code":"431","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"MASSAGE EA 15MIN","code_information":[{"code":"4300651","type":"CDM"},{"code":"431","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"NEUROMUSCULAR REED EA 15MIN","code_information":[{"code":"4300660","type":"CDM"},{"code":"431","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"PARAFFIN BATH","code_information":[{"code":"4300701","type":"CDM"},{"code":"431","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.75,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"PHONOPHORESIS EA 15MIN","code_information":[{"code":"4300710","type":"CDM"},{"code":"431","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"REEVALUATION","code_information":[{"code":"4300716","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"ORTHOTICS FAB/IT/TRA EA 15MIN","code_information":[{"code":"4300751","type":"CDM"},{"code":"431","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"PROSTHETIC TRAINING EA 15MIN","code_information":[{"code":"4300780","type":"CDM"},{"code":"431","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.75,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"ULTRASOUND-OT EA 15MIN","code_information":[{"code":"4300901","type":"CDM"},{"code":"431","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"THERAPEUTIC EX/PROC EA 15MIN","code_information":[{"code":"4300951","type":"CDM"},{"code":"431","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.75,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"VIDEOFLUO DYSPHAGIA EA 15MIN","code_information":[{"code":"4301000","type":"CDM"},{"code":"431","type":"RC"}],"standard_charges":[{"gross_charge":156.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"WHEELCHAIR EVL/TRN OT 15MIN EA","code_information":[{"code":"4301010","type":"CDM"},{"code":"431","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"WORK HARDENING ADD'L HR","code_information":[{"code":"4301065","type":"CDM"},{"code":"430","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"REINTEGRATION TRAINING EA 15M","code_information":[{"code":"4301066","type":"CDM"},{"code":"431","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"WOUND CARE W/MECH DEBR","code_information":[{"code":"4301073","type":"CDM"},{"code":"431","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"FUNCTIONAL CAPACITY EA 15MIN","code_information":[{"code":"4305441","type":"CDM"},{"code":"431","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"WORK HARDENING FIRST 2HR","code_information":[{"code":"4305954","type":"CDM"},{"code":"430","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.25,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT LOW COMPLEX-LC","code_information":[{"code":"4308016","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT MODERATE COMPLEX-LC","code_information":[{"code":"4308017","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"EVAL OT HIGH COMPLEX-LC","code_information":[{"code":"4308018","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"SP OCC THERAPY EVAL","code_information":[{"code":"4308077","type":"CDM"},{"code":"990","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"SP OCC THERAPY TX/15 MIN","code_information":[{"code":"4308078","type":"CDM"},{"code":"990","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.25,"setting":"both","billing_class":"facility"}]},{"description":"SPEECH SHIA REG EDUC /HOUR","code_information":[{"code":"4400112","type":"CDM"},{"code":"441","type":"RC"}],"standard_charges":[{"gross_charge":79.75,"setting":"both","billing_class":"professional"},{"gross_charge":112.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"SPEECH SHIA REG EDUC EA 30MIN","code_information":[{"code":"4400113","type":"CDM"},{"code":"441","type":"RC"}],"standard_charges":[{"gross_charge":40.75,"setting":"both","billing_class":"professional"},{"gross_charge":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"SPEECH VIDEO STROBOSCOPY EVAL","code_information":[{"code":"4400120","type":"CDM"},{"code":"441","type":"RC"},{"code":"31579","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.25,"setting":"both","billing_class":"professional"},{"gross_charge":653.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"SPEECH TH OVID HEA EA 15MIN","code_information":[{"code":"4400130","type":"CDM"},{"code":"442","type":"RC"}],"standard_charges":[{"gross_charge":35.5,"setting":"both","billing_class":"professional"},{"gross_charge":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"SPEECH LANGUAGE TREATMENT","code_information":[{"code":"4408302","type":"CDM"},{"code":"441","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.5,"setting":"both","billing_class":"professional"},{"gross_charge":599.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH LANGUAGE TREAT GRP","code_information":[{"code":"4408303","type":"CDM"},{"code":"443","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"setting":"both","billing_class":"professional"},{"gross_charge":152.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH TX SWALLOWING DYSF","code_information":[{"code":"4408305","type":"CDM"},{"code":"441","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.5,"setting":"both","billing_class":"professional"},{"gross_charge":599.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH SWALLOW ST W/VIDEOFL","code_information":[{"code":"4408306","type":"CDM"},{"code":"320","type":"RC"},{"code":"70371","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy"}]},{"description":"SPEECH EVAL OF APHASIA/HOUR","code_information":[{"code":"4408308","type":"CDM"},{"code":"444","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.75,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH VIDEOFLOR SWAL ASSEM","code_information":[{"code":"4408311","type":"CDM"},{"code":"444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH SWALLOW ASSESSMENT","code_information":[{"code":"4408312","type":"CDM"},{"code":"444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH FLUENCY EVAL","code_information":[{"code":"4408315","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH SOUND PROD EVAL","code_information":[{"code":"4408316","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH SOUND /LANG EVAL","code_information":[{"code":"4408317","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH VOICE EVAL","code_information":[{"code":"4408318","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH COGN TEST 1ST 15M","code_information":[{"code":"4408321","type":"CDM"},{"code":"441","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.25,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SPEECH COGN TEST EA ADDL 15M","code_information":[{"code":"4408322","type":"CDM"},{"code":"441","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Skilled Therapy | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"SP SPEECH THERAPY EVAL","code_information":[{"code":"4408323","type":"CDM"},{"code":"990","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"setting":"both","billing_class":"facility"}]},{"description":"SP SPEECH THERAPY TX","code_information":[{"code":"4408324","type":"CDM"},{"code":"990","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"setting":"both","billing_class":"facility"}]},{"description":"ER ADMIN HEPATITIS B VACC","code_information":[{"code":"4500010","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"setting":"both","billing_class":"facility"}]},{"description":"EXTERNAL PACEMAKER","code_information":[{"code":"4500177","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB-XXXX INFUSION","code_information":[{"code":"4500239","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLAN AND ETESEV INFUSION-ER","code_information":[{"code":"4500240","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"MINOR NURSING PROC-AC","code_information":[{"code":"4500300","type":"CDM"},{"code":"490","type":"RC"}],"standard_charges":[{"gross_charge":534.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-3S","code_information":[{"code":"4501019","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-AC","code_information":[{"code":"4501020","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-4S","code_information":[{"code":"4501021","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-4W","code_information":[{"code":"4501022","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-2N","code_information":[{"code":"4501024","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-INF","code_information":[{"code":"4501025","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-ICU","code_information":[{"code":"4501039","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIAG SC/IM-PCU","code_information":[{"code":"4501041","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLIC LONG ARM SPLINT","code_information":[{"code":"4509104","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLIC SHORT ARM SPLINT","code_information":[{"code":"4509124","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.5,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLIC LONG LEG SPLINT","code_information":[{"code":"4509505","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.25,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLIC SHORT LEG SPLINT","code_information":[{"code":"4509515","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.75,"setting":"both","billing_class":"facility"}]},{"description":"ER CATH FOR COLLECTION OF SPEC","code_information":[{"code":"4509612","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.75,"setting":"both","billing_class":"facility"}]},{"description":"ER FNA W/O IMAGE","code_information":[{"code":"4510021","type":"CDM"},{"code":"450","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.5,"setting":"both","billing_class":"facility"}]},{"description":"ER GUIDE CATHET FLUID DRAINAGE","code_information":[{"code":"4510030","type":"CDM"},{"code":"450","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D ABSCESS SIMPLE/SINGLE","code_information":[{"code":"4510060","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF SKIN ABSCESS","code_information":[{"code":"4510061","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.25,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D PILONIDAL CYST SIMPLE","code_information":[{"code":"4510080","type":"CDM"},{"code":"450","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.75,"setting":"both","billing_class":"facility"}]},{"description":"ER FB REMOVAL SUB-Q SIMPLE","code_information":[{"code":"4510120","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.75,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D HEMATOMA SIMPLE","code_information":[{"code":"4510140","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3932.25,"setting":"both","billing_class":"facility"}]},{"description":"ER PUNCTURE ASPIRATION ABSCESS","code_information":[{"code":"4510160","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.75,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D COMPLEX POST WND INFEC","code_information":[{"code":"4510180","type":"CDM"},{"code":"450","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3863.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DEBRIDE BONE 20CM OR LESS","code_information":[{"code":"4511044","type":"CDM"},{"code":"450","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3657.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL OF SKIN TAGS","code_information":[{"code":"4511200","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"}]},{"description":"ER EXC LESION FACE 1.1-2CM","code_information":[{"code":"4511442","type":"CDM"},{"code":"450","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.75,"setting":"both","billing_class":"facility"}]},{"description":"ER AVUL NAIL PLATE SIMPLE","code_information":[{"code":"4511730","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","billing_class":"facility"}]},{"description":"ER EVACUATION OF SUBUNGUAL HEM","code_information":[{"code":"4511740","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.5,"setting":"both","billing_class":"facility"}]},{"description":"ER NAIL BED EXC PART/COMPLETE","code_information":[{"code":"4511750","type":"CDM"},{"code":"450","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF NAIL BED","code_information":[{"code":"4511760","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.25,"setting":"both","billing_class":"facility"}]},{"description":"ER WEDGE EXC NAIL FOLD","code_information":[{"code":"4511765","type":"CDM"},{"code":"450","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE DRUG IMPLANT","code_information":[{"code":"4511982","type":"CDM"},{"code":"450","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR SIM 2.5/LESS","code_information":[{"code":"4512001","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.75,"setting":"both","billing_class":"facility"}]},{"description":"ER SIMPLE REPAIR 2.6 TO 7.5 CM","code_information":[{"code":"4512002","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR 7.6-12.5CM","code_information":[{"code":"4512004","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.25,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR 12.6-20.0CM","code_information":[{"code":"4512005","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.5,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR 20.1 - 30 CM","code_information":[{"code":"4512006","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR 2.5CM/LESS","code_information":[{"code":"4512011","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.75,"setting":"both","billing_class":"facility"}]},{"description":"ER SIMPL REPR FACE/ETC 2.6CM","code_information":[{"code":"4512013","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.5,"setting":"both","billing_class":"facility"}]},{"description":"ER SIMPL REPR FACE/ETC 5.1,7.5","code_information":[{"code":"4512014","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.25,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR 7.6-12.5CM","code_information":[{"code":"4512015","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.5,"setting":"both","billing_class":"facility"}]},{"description":"ER SIMPL REPR FACE/ 12.6-20 CM","code_information":[{"code":"4512016","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TRTMENT WOUND FACE CLOSURE","code_information":[{"code":"4512020","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.75,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSURE OF SPLIT WOUND","code_information":[{"code":"4512021","type":"CDM"},{"code":"450","type":"RC"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.75,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REP INTERMED 2.5/LESS","code_information":[{"code":"4512031","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.75,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REP INTERM 2.6-7.5CM","code_information":[{"code":"4512032","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR 7.6 cm to 12.5 cm","code_information":[{"code":"4512034","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR 12.6 CM TO 20.0 CM","code_information":[{"code":"4512035","type":"CDM"},{"code":"450","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.25,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REPAIR INTER 2.5/LES","code_information":[{"code":"4512041","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1922.5,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REP INTER 2.6-7.5CM","code_information":[{"code":"4512042","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR INT N/H/F/E 7.6-12.5","code_information":[{"code":"4512044","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.75,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REP INTERM 2.5/LESS","code_information":[{"code":"4512051","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.5,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND REP INTERM 2.6-5.0CM","code_information":[{"code":"4512052","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"setting":"both","billing_class":"facility"}]},{"description":"ER LYR CLOSE FACE 7.6-12.5CM","code_information":[{"code":"4512054","type":"CDM"},{"code":"450","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR SCALP/ARM/LEG COMPL","code_information":[{"code":"4513120","type":"CDM"},{"code":"450","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF WOUND OR LESION","code_information":[{"code":"4513121","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":3286.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR WOUND/LESION ADD-ON","code_information":[{"code":"4513122","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF WOUND OR LESION","code_information":[{"code":"4513131","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF WOUND OR LESION","code_information":[{"code":"4513132","type":"CDM"},{"code":"450","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1968.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR WOUND/LESION ADD-ON","code_information":[{"code":"4513133","type":"CDM"},{"code":"450","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF WOUND OR LESION","code_information":[{"code":"4513151","type":"CDM"},{"code":"450","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF WOUND OR LESION","code_information":[{"code":"4513152","type":"CDM"},{"code":"450","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2169.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR WOUND/LESION ADD-ON","code_information":[{"code":"4513153","type":"CDM"},{"code":"450","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INIT TREATMENT 1st DEG BUR","code_information":[{"code":"4516000","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DEBRIDEMENT SMALL W/O ANEST","code_information":[{"code":"4516020","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DEBRIDEMENT MED.W/O ANESTHE","code_information":[{"code":"4516025","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CHEMICAL CAUTERY, TISSUE","code_information":[{"code":"4517250","type":"CDM"},{"code":"450","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"setting":"both","billing_class":"facility"}]},{"description":"ER SKIN TISSUE PROCEDURE","code_information":[{"code":"4517999","type":"CDM"},{"code":"450","type":"RC"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.0,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D OF BREAST OR MASTOTOMY","code_information":[{"code":"4519020","type":"CDM"},{"code":"450","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3207.75,"setting":"both","billing_class":"facility"}]},{"description":"ER EXC TR-EXT B9 0.5 CM<","code_information":[{"code":"4519021","type":"CDM"},{"code":"450","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.25,"setting":"both","billing_class":"facility"}]},{"description":"ER PENETRATING WOUND EXTREMITY","code_information":[{"code":"4520103","type":"CDM"},{"code":"450","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":4065.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL OF FOREIGN BODY","code_information":[{"code":"4520520","type":"CDM"},{"code":"450","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INJECT TENDON ORIGIN/INSER","code_information":[{"code":"4520551","type":"CDM"},{"code":"450","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR FOREARM TENDON/MUSCL","code_information":[{"code":"4520552","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER INJ TRIGGER PNT 3 MUSCL","code_information":[{"code":"4520553","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN/INJ JNT/BURSA W/O US","code_information":[{"code":"4520600","type":"CDM"},{"code":"450","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INTERMED JOINT,BURSA OR CYS","code_information":[{"code":"4520605","type":"CDM"},{"code":"450","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN/INJ JNT/BURSA W/US","code_information":[{"code":"4520606","type":"CDM"},{"code":"450","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.0,"setting":"both","billing_class":"facility"}]},{"description":"ER ARTHRO MAJOR JOINT","code_information":[{"code":"4520610","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN/INJ MAJOR JOINT W/US","code_information":[{"code":"4520611","type":"CDM"},{"code":"450","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL SUPPORT IMPLANT","code_information":[{"code":"4520670","type":"CDM"},{"code":"450","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSE TEMPOROMANDIBULAR","code_information":[{"code":"4521480","type":"CDM"},{"code":"450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT CLAVICLE FX","code_information":[{"code":"4523515","type":"CDM"},{"code":"450","type":"RC"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":9530.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSED SCAPULAR W/ MANIPUL","code_information":[{"code":"4523575","type":"CDM"},{"code":"450","type":"RC"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":4435.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TX HUMERUS FX","code_information":[{"code":"4523605","type":"CDM"},{"code":"450","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSED SHOULDER W/ MANIPULA","code_information":[{"code":"4523650","type":"CDM"},{"code":"450","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"setting":"both","billing_class":"facility"}]},{"description":"ER SHOULDER MANIPU. W/ANESTHES","code_information":[{"code":"4523655","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3844.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT DISLOCATION/FRACTUR","code_information":[{"code":"4523665","type":"CDM"},{"code":"450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2655.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT DISLOCATION/FRACTUR","code_information":[{"code":"4523675","type":"CDM"},{"code":"450","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":4108.75,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D OF ARM BURSA","code_information":[{"code":"4523931","type":"CDM"},{"code":"450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CL TX HUM FX W/MANIPULATION","code_information":[{"code":"4524505","type":"CDM"},{"code":"450","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2189.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TRMT HUM EPICON FRAC W/MAN","code_information":[{"code":"4524565","type":"CDM"},{"code":"450","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":4181.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT HUMERUS FRACTURE","code_information":[{"code":"4524577","type":"CDM"},{"code":"450","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":2189.25,"setting":"both","billing_class":"facility"}]},{"description":"ER ELBOW DISLOCATE W/O ANESTH","code_information":[{"code":"4524600","type":"CDM"},{"code":"450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CL ELBOW DIS REQ ANESTHESI","code_information":[{"code":"4524605","type":"CDM"},{"code":"450","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4102.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT ELBOW FRACTURE","code_information":[{"code":"4524620","type":"CDM"},{"code":"450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.75,"setting":"both","billing_class":"facility"}]},{"description":"ER RADIAL HEAD SUBLUX CHILD","code_information":[{"code":"4524640","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.75,"setting":"both","billing_class":"facility"}]},{"description":"ER RADIAL HEAD,NECK WITH MANIP","code_information":[{"code":"4524655","type":"CDM"},{"code":"450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2791.25,"setting":"both","billing_class":"facility"}]},{"description":"ER UPPER ARM/ELBOW SURGERY","code_information":[{"code":"4524999","type":"CDM"},{"code":"450","type":"RC"},{"code":"24999","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FRACTURE OF RADIUS","code_information":[{"code":"4525505","type":"CDM"},{"code":"450","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3741.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CL TX RADIAL/ULNA FX","code_information":[{"code":"4525565","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2010.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FX RADIUS/ULNA","code_information":[{"code":"4525575","type":"CDM"},{"code":"450","type":"RC"},{"code":"25575","type":"HCPCS"}],"standard_charges":[{"gross_charge":10300.0,"setting":"both","billing_class":"facility"}]},{"description":"ER MANIPULATION W RADIAL FRACT","code_information":[{"code":"4525605","type":"CDM"},{"code":"450","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2491.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"4526010","type":"CDM"},{"code":"450","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"4526011","type":"CDM"},{"code":"450","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.5,"setting":"both","billing_class":"facility"}]},{"description":"ER EXPL/REM FOREIGN BODY JOINT","code_information":[{"code":"4526080","type":"CDM"},{"code":"450","type":"RC"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":2373.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR FINGER/HAND TENDON","code_information":[{"code":"4526350","type":"CDM"},{"code":"450","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":7171.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR TENDON HAND W/O GRAF","code_information":[{"code":"4526410","type":"CDM"},{"code":"450","type":"RC"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4355.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR TENDON FINTER W/GRAF","code_information":[{"code":"4526418","type":"CDM"},{"code":"450","type":"RC"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":4339.0,"setting":"both","billing_class":"facility"}]},{"description":"ER METACARPAL FRAC W/O MANIPUL","code_information":[{"code":"4526605","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TX DISLOC THUMB W MANIP","code_information":[{"code":"4526641","type":"CDM"},{"code":"450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT THUMB FRACTURE","code_information":[{"code":"4526645","type":"CDM"},{"code":"450","type":"RC"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2189.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT HAND DISLOCATION","code_information":[{"code":"4526670","type":"CDM"},{"code":"450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT KNUCKLE DISLOCATION","code_information":[{"code":"4526700","type":"CDM"},{"code":"450","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSED TREAT PHALANGEAL W/M","code_information":[{"code":"4526725","type":"CDM"},{"code":"450","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2565.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FINGER FRACTURE, EACH","code_information":[{"code":"4526742","type":"CDM"},{"code":"450","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":3531.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CL TX PHAL FX","code_information":[{"code":"4526755","type":"CDM"},{"code":"450","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.75,"setting":"both","billing_class":"facility"}]},{"description":"ER INTERPHALANGEAL JOINT DISLO","code_information":[{"code":"4526770","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2532.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FINGER DISLOCATION","code_information":[{"code":"4526775","type":"CDM"},{"code":"450","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":3080.5,"setting":"both","billing_class":"facility"}]},{"description":"ER HAND/FINGER SURGERY","code_information":[{"code":"4526989","type":"CDM"},{"code":"450","type":"RC"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1903.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CLSD HIP DISLOCATN W/O ANES","code_information":[{"code":"4527250","type":"CDM"},{"code":"450","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CLTX HIP DISLOCATION W/ANES","code_information":[{"code":"4527252","type":"CDM"},{"code":"450","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3638.0,"setting":"both","billing_class":"facility"},{"gross_charge":3638.0,"setting":"both","billing_class":"professional"}]},{"description":"ER TREAT HIP DISLOCATION","code_information":[{"code":"4527265","type":"CDM"},{"code":"450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT HIP DISLOCATION","code_information":[{"code":"4527266","type":"CDM"},{"code":"450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2413.5,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D DEEP, THIGH/KNEE","code_information":[{"code":"4527301","type":"CDM"},{"code":"450","type":"RC"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":3245.0,"setting":"both","billing_class":"facility"}]},{"description":"ER EXPLORE KNEE W/DRAIN/REM FB","code_information":[{"code":"4527310","type":"CDM"},{"code":"450","type":"RC"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":4496.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CLOSED TX TIBIAL FX","code_information":[{"code":"4527532","type":"CDM"},{"code":"450","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":4383.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT KNEE DISLOCATION","code_information":[{"code":"4527550","type":"CDM"},{"code":"450","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT KNEE DISLOCATION","code_information":[{"code":"4527552","type":"CDM"},{"code":"450","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3937.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT KNEECAP DISLOCATION","code_information":[{"code":"4527560","type":"CDM"},{"code":"450","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.25,"setting":"both","billing_class":"facility"}]},{"description":"ER PATELER DISLOCATON W/ANESTH","code_information":[{"code":"4527562","type":"CDM"},{"code":"450","type":"RC"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":2413.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR LEG FLEXOR TENDON","code_information":[{"code":"4527658","type":"CDM"},{"code":"450","type":"RC"},{"code":"27658","type":"HCPCS"}],"standard_charges":[{"gross_charge":4383.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TIBIAL SHAFT FX W/MANIPULA","code_information":[{"code":"4527752","type":"CDM"},{"code":"450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":4474.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"4527762","type":"CDM"},{"code":"450","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3757.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CLTX POST ANKLE FX W/MNPJ","code_information":[{"code":"4527768","type":"CDM"},{"code":"450","type":"RC"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF FIBULA FRACTU","code_information":[{"code":"4527781","type":"CDM"},{"code":"450","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3300.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"4527788","type":"CDM"},{"code":"450","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3237.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TX ANKLE FX W/O MANIPULATIO","code_information":[{"code":"4527808","type":"CDM"},{"code":"450","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TX ANKLE Fx W MANIPULATION","code_information":[{"code":"4527810","type":"CDM"},{"code":"450","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4572.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF ANKLE FRACTUR","code_information":[{"code":"4527818","type":"CDM"},{"code":"450","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":4756.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TIBIA W/SKELETAL TRACTION","code_information":[{"code":"4527825","type":"CDM"},{"code":"450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":5181.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT LOWER LEG DISLOCATION","code_information":[{"code":"4527830","type":"CDM"},{"code":"450","type":"RC"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":3430.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT ANKLE DISLOCATION","code_information":[{"code":"4527840","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.75,"setting":"both","billing_class":"facility"}]},{"description":"ER LEG/ANKLE PROCEDURE","code_information":[{"code":"4527899","type":"CDM"},{"code":"450","type":"RC"},{"code":"27899","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"setting":"both","billing_class":"facility"}]},{"description":"ER FB REMOVAL FOOT SIMPLE","code_information":[{"code":"4528190","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2097.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE OF FOREIGN BODY DEEP","code_information":[{"code":"4528192","type":"CDM"},{"code":"450","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2822.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT BIG TOE FRACTURE","code_information":[{"code":"4528495","type":"CDM"},{"code":"450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF TOE FRACTUR","code_information":[{"code":"4528515","type":"CDM"},{"code":"450","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.25,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FOOT DISLOCATION","code_information":[{"code":"4528540","type":"CDM"},{"code":"450","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT FOOT DISLOCATION","code_information":[{"code":"4528600","type":"CDM"},{"code":"450","type":"RC"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1681.25,"setting":"both","billing_class":"facility"}]},{"description":"ER JOINT DISLOCATION W/O ANES","code_information":[{"code":"4528630","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT TOE DISLOCATION","code_information":[{"code":"4528660","type":"CDM"},{"code":"450","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.5,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLICATION FINGER SPLINT","code_information":[{"code":"4529130","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.75,"setting":"both","billing_class":"facility"}]},{"description":"ER STRAPPING OF SHOULDER","code_information":[{"code":"4529240","type":"CDM"},{"code":"450","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"setting":"both","billing_class":"facility"}]},{"description":"ER STRAPPING OF ELBOW OR WRIST","code_information":[{"code":"4529260","type":"CDM"},{"code":"450","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"setting":"both","billing_class":"facility"}]},{"description":"ER STRAPPING OF HAND OR FINGER","code_information":[{"code":"4529280","type":"CDM"},{"code":"450","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLICATION LONG LEG CAST","code_information":[{"code":"4529345","type":"CDM"},{"code":"450","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.5,"setting":"both","billing_class":"facility"}]},{"description":"ER APPLICATION CYLINDER CAST","code_information":[{"code":"4529405","type":"CDM"},{"code":"450","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL/REVISION OF CAST","code_information":[{"code":"4529700","type":"CDM"},{"code":"450","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REMVE,REPAIR F ARM,LEG CAST","code_information":[{"code":"4529705","type":"CDM"},{"code":"450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CASTING/STRAPING PROCEDURE","code_information":[{"code":"4529799","type":"CDM"},{"code":"450","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT METATARSAL FRACTURE","code_information":[{"code":"4529800","type":"CDM"},{"code":"450","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL INTRANASAL LESION","code_information":[{"code":"4530117","type":"CDM"},{"code":"450","type":"RC"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":3907.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE FOREIGN BODY,INTRANA","code_information":[{"code":"4530300","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVAL FB INTRANASAL","code_information":[{"code":"4530320","type":"CDM"},{"code":"450","type":"RC"},{"code":"30320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1867.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CONTROL NASAL HEMORR SIMPLE","code_information":[{"code":"4530901","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.5,"setting":"both","billing_class":"facility"}]},{"description":"ER CONTROL NASAL HEMORR COMPL","code_information":[{"code":"4530903","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.25,"setting":"both","billing_class":"facility"}]},{"description":"ER NASAL HEMORRHAGE POSTERIOR","code_information":[{"code":"4530905","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":2127.0,"setting":"both","billing_class":"facility"}]},{"description":"ER NASAL HEMORRHAGE SUBSEQUEN","code_information":[{"code":"4530906","type":"CDM"},{"code":"450","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INTUBATION","code_information":[{"code":"4531500","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.25,"setting":"both","billing_class":"facility"}]},{"description":"ER EMERGENT INCISION WINDPIPE","code_information":[{"code":"4531605","type":"CDM"},{"code":"450","type":"RC"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.5,"setting":"both","billing_class":"facility"},{"gross_charge":514.5,"setting":"both","billing_class":"professional"}]},{"description":"ER DX BRONCHOSCOPE/WASH","code_information":[{"code":"4531622","type":"CDM"},{"code":"450","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3679.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERT OF CHEST TUBE","code_information":[{"code":"4532551","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2619.0,"setting":"both","billing_class":"facility"}]},{"description":"ER PERICARDIOCENTESIS FLUOR/US","code_information":[{"code":"4532554","type":"CDM"},{"code":"450","type":"RC"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"setting":"both","billing_class":"facility"}]},{"description":"ER THORACENTESIS W/IMAGING","code_information":[{"code":"4532555","type":"CDM"},{"code":"450","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERT CATH PLEURA W/O IMAG","code_information":[{"code":"4532556","type":"CDM"},{"code":"450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.0,"setting":"both","billing_class":"facility"}]},{"description":"ER THORACENTESIS W/O IMAGING","code_information":[{"code":"4532558","type":"CDM"},{"code":"450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INSER OR REPL TEMP TRANSVE","code_information":[{"code":"4533210","type":"CDM"},{"code":"450","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":13052.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR BLOOD VESSEL LESION","code_information":[{"code":"4535206","type":"CDM"},{"code":"450","type":"RC"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":5884.25,"setting":"both","billing_class":"facility"}]},{"description":"ER INTRO NEEDLE EXTREMITY ARTE","code_information":[{"code":"4536140","type":"CDM"},{"code":"450","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3536.75,"setting":"both","billing_class":"facility"}]},{"description":"ER NON-ROUTINE BL DRAW > 3YR","code_information":[{"code":"4536410","type":"CDM"},{"code":"450","type":"RC"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"setting":"both","billing_class":"facility"}]},{"description":"ER VENIPUNCTURE 1 YR OR OVER","code_information":[{"code":"4536425","type":"CDM"},{"code":"450","type":"RC"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"setting":"both","billing_class":"facility"}]},{"description":"ER BLOOD TRANSFUSION","code_information":[{"code":"4536430","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CENTRAL LINE INSERT","code_information":[{"code":"4536556","type":"CDM"},{"code":"450","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERT PICC CATH <5YRS","code_information":[{"code":"4536568","type":"CDM"},{"code":"450","type":"RC"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"setting":"both","billing_class":"facility"}]},{"description":"ER PICC W/O IMG GDN","code_information":[{"code":"4536569","type":"CDM"},{"code":"450","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3273.0,"setting":"both","billing_class":"facility"}]},{"description":"ER PICC W/ US","code_information":[{"code":"4536573","type":"CDM"},{"code":"450","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1728.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REPLACE PICC CATH","code_information":[{"code":"4536584","type":"CDM"},{"code":"450","type":"RC"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DECLOT VASCULAR DEVICE","code_information":[{"code":"4536593","type":"CDM"},{"code":"450","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.25,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERTION CATHETER, ARTERY","code_information":[{"code":"4536620","type":"CDM"},{"code":"450","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.75,"setting":"both","billing_class":"facility"}]},{"description":"ER PLACE NEEDLE FOR INTRAOSSE","code_information":[{"code":"4536680","type":"CDM"},{"code":"450","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"setting":"both","billing_class":"facility"}]},{"description":"ER VASCULAR SURGERY UNLISTED","code_information":[{"code":"4537799","type":"CDM"},{"code":"450","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2581.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR LIP FULL THICKN VERM","code_information":[{"code":"4540650","type":"CDM"},{"code":"450","type":"RC"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE ABS MOUTH","code_information":[{"code":"4540800","type":"CDM"},{"code":"450","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR TONGUE LACERATION","code_information":[{"code":"4541250","type":"CDM"},{"code":"450","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR TONGUE LACERATION","code_information":[{"code":"4541252","type":"CDM"},{"code":"450","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF GUM LESION","code_information":[{"code":"4541800","type":"CDM"},{"code":"450","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.75,"setting":"both","billing_class":"facility"}]},{"description":"ER UNLISTED DENTOALVEOLAR PROC","code_information":[{"code":"4541899","type":"CDM"},{"code":"450","type":"RC"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE MOUTH ROOF LESION","code_information":[{"code":"4542000","type":"CDM"},{"code":"450","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"setting":"both","billing_class":"facility"}]},{"description":"ER UNLISTED PROC PALATE/UVULA","code_information":[{"code":"4542299","type":"CDM"},{"code":"450","type":"RC"},{"code":"42299","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"4542300","type":"CDM"},{"code":"450","type":"RC"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.75,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D ABSCESS","code_information":[{"code":"4542700","type":"CDM"},{"code":"450","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE PHARYNX FOREIGN BOD","code_information":[{"code":"4542809","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CONTROL THROAT BLEEDING","code_information":[{"code":"4542960","type":"CDM"},{"code":"450","type":"RC"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1494.5,"setting":"both","billing_class":"facility"}]},{"description":"ER UNLISTED PROC PHAR/ADEN/TON","code_information":[{"code":"4542999","type":"CDM"},{"code":"450","type":"RC"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.5,"setting":"both","billing_class":"facility"}]},{"description":"ER UPPR GI ENDOSCOPY, DIAG","code_information":[{"code":"4543235","type":"CDM"},{"code":"450","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3088.75,"setting":"both","billing_class":"facility"}]},{"description":"ER EGD CONTROL BLEEDING ANY","code_information":[{"code":"4543255","type":"CDM"},{"code":"450","type":"RC"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":4312.0,"setting":"both","billing_class":"facility"}]},{"description":"ER GASTRIC INTUBATION","code_information":[{"code":"4543753","type":"CDM"},{"code":"450","type":"RC"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"setting":"both","billing_class":"facility"}]},{"description":"ER RPLC GTUBE NO REVJ TRC","code_information":[{"code":"4543762","type":"CDM"},{"code":"450","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.75,"setting":"both","billing_class":"facility"}]},{"description":"ER STOMACH PROCEDURE","code_information":[{"code":"4543999","type":"CDM"},{"code":"450","type":"RC"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.25,"setting":"both","billing_class":"facility"}]},{"description":"ER INTRO OF LONG GASTRO TUBE","code_information":[{"code":"4544500","type":"CDM"},{"code":"450","type":"RC"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.5,"setting":"both","billing_class":"facility"}]},{"description":"ER UNLISTED PROCEDURE INTESTI","code_information":[{"code":"4544799","type":"CDM"},{"code":"450","type":"RC"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF RECTAL ABSCESS","code_information":[{"code":"4545005","type":"CDM"},{"code":"450","type":"RC"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE RECTAL OBSTRUCTION","code_information":[{"code":"4545915","type":"CDM"},{"code":"450","type":"RC"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":2690.75,"setting":"both","billing_class":"facility"}]},{"description":"ER RECTUM SURGERY PROCEDURE","code_information":[{"code":"4545999","type":"CDM"},{"code":"450","type":"RC"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2423.75,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D OF RECTAL ABCESS","code_information":[{"code":"4546040","type":"CDM"},{"code":"450","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3975.25,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D OF ANAL ABSCESS","code_information":[{"code":"4546050","type":"CDM"},{"code":"450","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1922.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INCISION THROMP HEMORRHOID","code_information":[{"code":"4546083","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REM OF HEMORRHOID CLOT","code_information":[{"code":"4546320","type":"CDM"},{"code":"450","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2558.25,"setting":"both","billing_class":"facility"},{"gross_charge":2485.0,"setting":"both","billing_class":"professional"}]},{"description":"ER ANUS PROCEDURE","code_information":[{"code":"4546999","type":"CDM"},{"code":"450","type":"RC"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1201.25,"setting":"both","billing_class":"facility"}]},{"description":"ER ABD PARACENTESIS","code_information":[{"code":"4549082","type":"CDM"},{"code":"450","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.5,"setting":"both","billing_class":"facility"}]},{"description":"ER PARACENTESIS","code_information":[{"code":"4549083","type":"CDM"},{"code":"450","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPLACE G/C TUBE PERC","code_information":[{"code":"4549450","type":"CDM"},{"code":"450","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN BLAD W/CATH INSERTION","code_information":[{"code":"4551102","type":"CDM"},{"code":"450","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1717.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IRRIGATION OF BLADDER","code_information":[{"code":"4551700","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERT STRAIGHT BLAD CATH","code_information":[{"code":"4551701","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.25,"setting":"both","billing_class":"facility"}]},{"description":"ER INSERT BLADDER CATH-FOLEY","code_information":[{"code":"4551702","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CHARGE CYSTOSTOMY TUBE SIMP","code_information":[{"code":"4551705","type":"CDM"},{"code":"450","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DIL URETH STRICT","code_information":[{"code":"4553600","type":"CDM"},{"code":"450","type":"RC"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DILATE URETHRA STRICTURE","code_information":[{"code":"4553620","type":"CDM"},{"code":"450","type":"RC"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.25,"setting":"both","billing_class":"facility"}]},{"description":"ER SLITTING OF PREPUCE","code_information":[{"code":"4554001","type":"CDM"},{"code":"450","type":"RC"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3938.75,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF PENIS LESION","code_information":[{"code":"4554220","type":"CDM"},{"code":"450","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2423.5,"setting":"both","billing_class":"facility"}]},{"description":"ER PREPUTIAL STRETCHING","code_information":[{"code":"4554450","type":"CDM"},{"code":"450","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF SCROTUM","code_information":[{"code":"4554700","type":"CDM"},{"code":"450","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3903.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF SCROTUM ABSCES","code_information":[{"code":"4555100","type":"CDM"},{"code":"450","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE FOREIGN BODY SCROTUM","code_information":[{"code":"4555120","type":"CDM"},{"code":"450","type":"RC"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3903.0,"setting":"both","billing_class":"facility"}]},{"description":"ER INSISION & DRAIN VULVA OR","code_information":[{"code":"4556405","type":"CDM"},{"code":"450","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"setting":"both","billing_class":"facility"}]},{"description":"ER I&D OF BARTHOLIN GLAND","code_information":[{"code":"4556420","type":"CDM"},{"code":"450","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.25,"setting":"both","billing_class":"facility"}]},{"description":"ER COLPOTOMY","code_information":[{"code":"4557010","type":"CDM"},{"code":"450","type":"RC"},{"code":"57010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3748.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREAT VAGINAL BLEEDING","code_information":[{"code":"4557180","type":"CDM"},{"code":"450","type":"RC"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR OF VAGINA","code_information":[{"code":"4557200","type":"CDM"},{"code":"450","type":"RC"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5214.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR VAGINA/PERINEUM","code_information":[{"code":"4557210","type":"CDM"},{"code":"450","type":"RC"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":5214.75,"setting":"both","billing_class":"facility"}]},{"description":"ER CAUTERY OF CERVIX","code_information":[{"code":"4557510","type":"CDM"},{"code":"450","type":"RC"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3683.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DILATE CERVICAL CANAL","code_information":[{"code":"4557800","type":"CDM"},{"code":"450","type":"RC"},{"code":"57800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3703.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE INTRAUTERINE DEVICE","code_information":[{"code":"4558301","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TREATMENT OF MISCARRIAGE","code_information":[{"code":"4559812","type":"CDM"},{"code":"450","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":6896.0,"setting":"both","billing_class":"facility"}]},{"description":"ER MATERNITY CARE PROCEDURE","code_information":[{"code":"4559899","type":"CDM"},{"code":"450","type":"RC"},{"code":"59899","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"setting":"both","billing_class":"facility"}]},{"description":"ER SPINAL PUNCTURE,LUMBAR","code_information":[{"code":"4562270","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"4562272","type":"CDM"},{"code":"450","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INJECTION EPIDURAL BLOOD","code_information":[{"code":"4562273","type":"CDM"},{"code":"450","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"ER INJECTION FOR NERVE BLOCK","code_information":[{"code":"4564400","type":"CDM"},{"code":"450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER N BLOCK INJ, OCCIPITAL","code_information":[{"code":"4564405","type":"CDM"},{"code":"450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.25,"setting":"both","billing_class":"facility"}]},{"description":"ER NERVE BLOCK INJECTION","code_information":[{"code":"4564450","type":"CDM"},{"code":"450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.5,"setting":"both","billing_class":"facility"}]},{"description":"ER N BLOCK SPENOPALATINE GANGL","code_information":[{"code":"4564505","type":"CDM"},{"code":"450","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.25,"setting":"both","billing_class":"facility"}]},{"description":"ER EYE FB REMOVAL EXTERNAL","code_information":[{"code":"4565205","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE FOR BODY CONJUN EMBE","code_information":[{"code":"4565210","type":"CDM"},{"code":"450","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"setting":"both","billing_class":"facility"}]},{"description":"ER EYE CORNEAL FB W OUT SLIT","code_information":[{"code":"4565220","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.5,"setting":"both","billing_class":"facility"}]},{"description":"ER FOREIGN BODY CORNEAL SLIT","code_information":[{"code":"4565222","type":"CDM"},{"code":"450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.25,"setting":"both","billing_class":"facility"}]},{"description":"ER FOREIGN BODY INTRACULAR","code_information":[{"code":"4565235","type":"CDM"},{"code":"450","type":"RC"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":4930.5,"setting":"both","billing_class":"facility"}]},{"description":"ER REPAIR CORNEA LACERATION","code_information":[{"code":"4565275","type":"CDM"},{"code":"450","type":"RC"},{"code":"65275","type":"HCPCS"}],"standard_charges":[{"gross_charge":4987.5,"setting":"both","billing_class":"facility"}]},{"description":"ER UNLISTED PROCEDURE ANT EYE","code_information":[{"code":"4566999","type":"CDM"},{"code":"450","type":"RC"},{"code":"66999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3029.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAINAGE OF EYELID ABSCESS","code_information":[{"code":"4567700","type":"CDM"},{"code":"450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.25,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE EYELID FOREIGN BODY","code_information":[{"code":"4567938","type":"CDM"},{"code":"450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN EXTERNAL EAR ABSCESS","code_information":[{"code":"4569000","type":"CDM"},{"code":"450","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DRAIN OUTER EAR CANAL LESIO","code_information":[{"code":"4569020","type":"CDM"},{"code":"450","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.75,"setting":"both","billing_class":"facility"}]},{"description":"ER EAR FB REMOVAL EXTERNAL","code_information":[{"code":"4569200","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.75,"setting":"both","billing_class":"facility"}]},{"description":"ER REMOVE IMPACTED EAR WAX","code_information":[{"code":"4569209","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.25,"setting":"both","billing_class":"facility"}]},{"description":"ER EAR WAX REMOVAL IMPACTED","code_information":[{"code":"4569210","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"setting":"both","billing_class":"facility"}]},{"description":"ER EAR WAX REMOVAL IMPACTED","code_information":[{"code":"4569210","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":204.0,"setting":"both","billing_class":"professional"}]},{"description":"ER OUTER EAR SURGERY PROCEDURE","code_information":[{"code":"4569399","type":"CDM"},{"code":"450","type":"RC"},{"code":"69399","type":"HCPCS"}],"standard_charges":[{"gross_charge":3796.5,"setting":"both","billing_class":"facility"}]},{"description":"ER OUTER EAR SURGERY PROCEDURE","code_information":[{"code":"4569399","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":2700.0,"setting":"both","billing_class":"professional"}]},{"description":"ER OCULAR US","code_information":[{"code":"4576512","type":"CDM"},{"code":"402","type":"RC"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.25,"setting":"both","billing_class":"facility"}]},{"description":"ER HEAD & NECK US","code_information":[{"code":"4576536","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.75,"setting":"both","billing_class":"facility"}]},{"description":"ER FAST CHEST US","code_information":[{"code":"4576604","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1681.25,"setting":"both","billing_class":"facility"}]},{"description":"ER BREAST ULTRASOUND-RT","code_information":[{"code":"4576642","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ER BREAST ULTRASOUND-LT","code_information":[{"code":"4576643","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ER FAST ABD/GALLBLADDER US","code_information":[{"code":"4576705","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.25,"setting":"both","billing_class":"facility"}]},{"description":"ER RENAL/AORTA US","code_information":[{"code":"4576775","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TA OB <14 WEEKS US","code_information":[{"code":"4576815","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.5,"setting":"both","billing_class":"facility"}]},{"description":"ER NON OB TRANSV US","code_information":[{"code":"4576830","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.75,"setting":"both","billing_class":"facility"}]},{"description":"ER BLADDER VOLUME US","code_information":[{"code":"4576857","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.5,"setting":"both","billing_class":"facility"}]},{"description":"ER EXTREMITY US-RT","code_information":[{"code":"4576882","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"ER EXTREMITY US-LT","code_information":[{"code":"4576883","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"ER PEDS HIP US","code_information":[{"code":"4576886","type":"CDM"},{"code":"402","type":"RC"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.25,"setting":"both","billing_class":"facility"}]},{"description":"ER VASCULAR ACCESS US","code_information":[{"code":"4576937","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.25,"setting":"both","billing_class":"facility"}]},{"description":"ER NEEDLE GUIDANCE US","code_information":[{"code":"4576942","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TB SKIN TEST","code_information":[{"code":"4586580","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"}]},{"description":"ER TB SKIN TEST","code_information":[{"code":"4586580","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":87.0,"setting":"both","billing_class":"professional"}]},{"description":"ER N BLOCK INJ, OCCIPITAL BIL","code_information":[{"code":"4590005","type":"CDM"},{"code":"450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"ER FLU VACCINE ADMIN","code_information":[{"code":"4590008","type":"CDM"},{"code":"450","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"ER CASIRIVI AND IMDEVI INJ","code_information":[{"code":"4590243","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"ER CASIRIVIMAB-XXXX INFUSION","code_information":[{"code":"4590244","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"ER IMMUNIZATION ADMIN","code_information":[{"code":"4590471","type":"CDM"},{"code":"450","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IMMUNI ADMIN ADD VACCINE","code_information":[{"code":"4590472","type":"CDM"},{"code":"450","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"}]},{"description":"ER DIPHTHERIA & TENTANUS TOXOI","code_information":[{"code":"4590702","type":"CDM"},{"code":"450","type":"RC"},{"code":"90702","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.5,"setting":"both","billing_class":"facility"}]},{"description":"ER NASOPHARYNGOSCOPY","code_information":[{"code":"4592511","type":"CDM"},{"code":"450","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CLTX THIGH FX W/MNPJ","code_information":[{"code":"4592512","type":"CDM"},{"code":"450","type":"RC"},{"code":"27268","type":"HCPCS"}],"standard_charges":[{"gross_charge":4011.5,"setting":"both","billing_class":"facility"}]},{"description":"ER RESUSCITATION","code_information":[{"code":"4592950","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"setting":"both","billing_class":"facility"}]},{"description":"ER TEMP TRANSCUTANEOUS PACING","code_information":[{"code":"4592953","type":"CDM"},{"code":"450","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"setting":"both","billing_class":"facility"}]},{"description":"ER CARDIO,ELEC CONVER OF ARRHY","code_information":[{"code":"4592960","type":"CDM"},{"code":"450","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":4606.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DISSOLVE HEART CLOT IV INFU","code_information":[{"code":"4592977","type":"CDM"},{"code":"450","type":"RC"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DISSOLVE HEART CLOT IV INFU","code_information":[{"code":"4592977","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":750.75,"setting":"both","billing_class":"professional"}]},{"description":"ER FAST ECHO US","code_information":[{"code":"4593308","type":"CDM"},{"code":"480","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.5,"setting":"both","billing_class":"facility"}]},{"description":"ER AIRWAY INHALATION TREATMENT","code_information":[{"code":"4594640","type":"CDM"},{"code":"450","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.75,"setting":"both","billing_class":"facility"}]},{"description":"ER NONINVAS EAR OR PULSE OXIME","code_information":[{"code":"4594760","type":"CDM"},{"code":"450","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"setting":"both","billing_class":"facility"}]},{"description":"ER IV THERAPY HYDRATION INITAL","code_information":[{"code":"4596360","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IV THER HYDRATION ADDL","code_information":[{"code":"4596361","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IV THERAPY DIAG 1ST HR","code_information":[{"code":"4596365","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"setting":"both","billing_class":"facility"}]},{"description":"ER IV THERAPY DIAG ADDL HR","code_information":[{"code":"4596366","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IV INFUSION ADDL DRUG","code_information":[{"code":"4596367","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility"}]},{"description":"ER IV THERAPY CONCURRENT","code_information":[{"code":"4596368","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility"}]},{"description":"ER INJ THER/PROPH/DIAG SC/IM","code_information":[{"code":"4596372","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DIAG INJ IV PUSH INIT","code_information":[{"code":"4596374","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"ER DIAG INJ IV PUSH ADDL DRUG","code_information":[{"code":"4596375","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"ER DIAG INJ IV PUSH ADDL DRUG","code_information":[{"code":"4596376","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"ER IRRIG DRUG DELIVERY DEVICE","code_information":[{"code":"4596523","type":"CDM"},{"code":"940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.75,"setting":"both","billing_class":"facility"}]},{"description":"ER DEBRIDEMENT 20CM OR LESS","code_information":[{"code":"4597597","type":"CDM"},{"code":"450","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.25,"setting":"both","billing_class":"facility"}]},{"description":"ER WOUND CARE W/O ANES NON-SEL","code_information":[{"code":"4597602","type":"CDM"},{"code":"450","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"setting":"both","billing_class":"facility"}]},{"description":"ER OSTEOPATHIC MANIPULATION","code_information":[{"code":"4598925","type":"CDM"},{"code":"450","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.5,"setting":"both","billing_class":"facility"}]},{"description":"ER MODERATE SEDATION <5","code_information":[{"code":"4599151","type":"CDM"},{"code":"450","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"setting":"both","billing_class":"facility"}]},{"description":"ER MODERATE SEDATION","code_information":[{"code":"4599152","type":"CDM"},{"code":"450","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"setting":"both","billing_class":"facility"}]},{"description":"ER MOD SED SAME PHYS EA ADD 15","code_information":[{"code":"4599153","type":"CDM"},{"code":"450","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.25,"setting":"both","billing_class":"facility"}]},{"description":"ER MOD SEDATION INI 15M","code_information":[{"code":"4599156","type":"CDM"},{"code":"450","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 1","code_information":[{"code":"4599281","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 2","code_information":[{"code":"4599282","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 3","code_information":[{"code":"4599283","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.75,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 4","code_information":[{"code":"4599284","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2164.5,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 5","code_information":[{"code":"4599285","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2395.5,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY ROOM TREATMENT 5","code_information":[{"code":"4599285","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":2327.0,"setting":"both","billing_class":"professional"}]},{"description":"EMER CRITICAL CARE,EVAL & MANA","code_information":[{"code":"4599291","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":4571.75,"setting":"both","billing_class":"facility"}]},{"description":"EMER CRITICAL CARE, ADD 30 MIN","code_information":[{"code":"4599292","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":2159.75,"setting":"both","billing_class":"facility"}]},{"description":"TRAUMA ACTIVATE W/O NOTIFY","code_information":[{"code":"4599293","type":"CDM"},{"code":"684","type":"RC"}],"standard_charges":[{"gross_charge":6767.25,"setting":"both","billing_class":"facility"}]},{"description":"ER SOTROVIMAB INFUSION-ER","code_information":[{"code":"4599297","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"TIXAGEV AND CILGAV INJ ADM-ER","code_information":[{"code":"4599298","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BEBTELOVIMAB INJ ADM-ER","code_information":[{"code":"4599299","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"METHACHOLINE CHALLENGE (PFT)","code_information":[{"code":"4600050","type":"CDM"},{"code":"460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.25,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHIAL ALLERGY TESTS","code_information":[{"code":"4600055","type":"CDM"},{"code":"924","type":"RC"},{"code":"95070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.5,"setting":"both","billing_class":"facility"},{"gross_charge":1128.25,"setting":"both","billing_class":"professional"}]},{"description":"SPIROMETRY","code_information":[{"code":"4600070","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHOSPASM PRE/POST-SPIROMET","code_information":[{"code":"4600080","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.75,"setting":"both","billing_class":"facility"}]},{"description":"VITAL CAPACITY-PEAK","code_information":[{"code":"4600091","type":"CDM"},{"code":"460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.75,"setting":"both","billing_class":"facility"}]},{"description":"GAS EXCHANGE REST","code_information":[{"code":"4600130","type":"CDM"},{"code":"460","type":"RC"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.25,"setting":"both","billing_class":"facility"}]},{"description":"GAS EXCHANGE REST/EXERCISE","code_information":[{"code":"4600140","type":"CDM"},{"code":"460","type":"RC"},{"code":"94680","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.5,"setting":"both","billing_class":"facility"}]},{"description":"RESPONSE TO HYPOXIA","code_information":[{"code":"4600170","type":"CDM"},{"code":"460","type":"RC"},{"code":"94450","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"setting":"both","billing_class":"facility"}]},{"description":"PUL REH 1 ON 1/15min NON COPD","code_information":[{"code":"4600237","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.25,"setting":"both","billing_class":"facility"}]},{"description":"PUL REH/STRESS TEST 6 MIN WALK","code_information":[{"code":"4600238","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.75,"setting":"both","billing_class":"facility"}]},{"description":"PUL REH GROUP SESSION NON COPD","code_information":[{"code":"4600239","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"setting":"both","billing_class":"facility"}]},{"description":"PUL REH GROUP SESSION COPD","code_information":[{"code":"4600424","type":"CDM"},{"code":"948","type":"RC"},{"code":"G0424","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility"}]},{"description":"PHY/QHP OP PULM RHB W/O MNTR","code_information":[{"code":"4600425","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.75,"setting":"both","billing_class":"facility"}]},{"description":"PENTAMIDINE TREATMENT","code_information":[{"code":"4694642","type":"CDM"},{"code":"460","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"setting":"both","billing_class":"facility"}]},{"description":"VEST-MECHANIC CHEST WALL OSCIL","code_information":[{"code":"4694669","type":"CDM"},{"code":"410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.75,"setting":"both","billing_class":"facility"}]},{"description":"PLETHYSMOGRPHY-VLM/RESIST(PFT)","code_information":[{"code":"4694726","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.75,"setting":"both","billing_class":"facility"}]},{"description":"GAS DILUT/WASHOUT FOR VOLUMES","code_information":[{"code":"4694727","type":"CDM"},{"code":"460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.25,"setting":"both","billing_class":"facility"}]},{"description":"OSCILLOMETRY AIRWAY RESISTANCE","code_information":[{"code":"4694728","type":"CDM"},{"code":"460","type":"RC"},{"code":"94728","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.5,"setting":"both","billing_class":"facility"}]},{"description":"DIFFUSING CAPACITY","code_information":[{"code":"4694729","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.25,"setting":"both","billing_class":"facility"}]},{"description":"CARS/BD TST INFT-12MO 60 OB/3N","code_information":[{"code":"4694780","type":"CDM"},{"code":"460","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"facility"}]},{"description":"CARS/BD TST 12MO  OB/3N","code_information":[{"code":"4694781","type":"CDM"},{"code":"460","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.75,"setting":"both","billing_class":"facility"}]},{"description":"CARDIOVERSION EXTERNAL","code_information":[{"code":"4800011","type":"CDM"},{"code":"480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":4387.25,"setting":"both","billing_class":"facility"}]},{"description":"ECHO 2D LIMITED","code_information":[{"code":"4800015","type":"CDM"},{"code":"480","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.25,"setting":"both","billing_class":"facility"}]},{"description":"ECHO CF DOPPLER MAPPING ADD ON","code_information":[{"code":"4800020","type":"CDM"},{"code":"480","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"setting":"both","billing_class":"facility"}]},{"description":"EXERCISE STRESS TEST","code_information":[{"code":"4800103","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.75,"setting":"both","billing_class":"facility"}]},{"description":"PW/CW DOPPLER ADD ON CODE","code_information":[{"code":"4800200","type":"CDM"},{"code":"480","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"setting":"both","billing_class":"facility"}]},{"description":"ECHO 2D CF DOPP COMPLETE","code_information":[{"code":"4800205","type":"CDM"},{"code":"480","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3210.5,"setting":"both","billing_class":"facility"}]},{"description":"TTE ECHO WITH CONTRAST","code_information":[{"code":"4800211","type":"CDM"},{"code":"483","type":"RC"},{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.0,"setting":"both","billing_class":"facility"}]},{"description":"STRESS ECHO W/O CONTRAST","code_information":[{"code":"4800212","type":"CDM"},{"code":"480","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.0,"setting":"both","billing_class":"facility"},{"gross_charge":1162.0,"setting":"both","billing_class":"professional"}]},{"description":"ADMIN ECHO CONTRAST AGENT","code_information":[{"code":"4800213","type":"CDM"},{"code":"483","type":"RC"},{"code":"93352","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"},{"gross_charge":76.5,"setting":"both","billing_class":"professional"}]},{"description":"TRANSESOPHAGEAL ECHO CONGENIT","code_information":[{"code":"4800219","type":"CDM"},{"code":"480","type":"RC"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"setting":"both","billing_class":"facility"}]},{"description":"TRANSESOPHAGEAL ECHO COMPLETE","code_information":[{"code":"4800220","type":"CDM"},{"code":"480","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"setting":"both","billing_class":"facility"}]},{"description":"TRANSESOPHAGEAL ECHO","code_information":[{"code":"4800221","type":"CDM"},{"code":"480","type":"RC"}],"standard_charges":[{"gross_charge":1248.0,"setting":"both","billing_class":"facility"}]},{"description":"INTRRG EVL PM/LDLS PM INPERSON","code_information":[{"code":"4893288","type":"CDM"},{"code":"480","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"facility"}]},{"description":"REMOTE INTERROG EVL PM/IDS","code_information":[{"code":"4893290","type":"CDM"},{"code":"480","type":"RC"},{"code":"93296","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.25,"setting":"both","billing_class":"facility"},{"gross_charge":79.75,"setting":"both","billing_class":"professional"}]},{"description":"HEMORROIDECTOMY","code_information":[{"code":"4900004","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3207.25,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHOSCOPY W/ BIOPSY","code_information":[{"code":"4900011","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":8117.5,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHOSCOPY","code_information":[{"code":"4900050","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2656.5,"setting":"both","billing_class":"facility"}]},{"description":"BRONCHOSCOPY W FLOUROSCOPY","code_information":[{"code":"4900051","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":3497.5,"setting":"both","billing_class":"facility"}]},{"description":"EBUS-BRONCH W/ ENDOBRONCH US","code_information":[{"code":"4900052","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":8187.75,"setting":"both","billing_class":"facility"}]},{"description":"BRUSHINGS-BRONCH","code_information":[{"code":"4900060","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1943.25,"setting":"both","billing_class":"facility"}]},{"description":"CAPNOGRAPHY EQUIP-SDC","code_information":[{"code":"4900070","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":218.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W POLYPECTOMY","code_information":[{"code":"4900080","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5922.75,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W EGD","code_information":[{"code":"4900090","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":6845.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY SCREEN/DIAG","code_information":[{"code":"4900091","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":4566.5,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY REMOVAL FB","code_information":[{"code":"4900100","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2371.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY DIL W BALLOON","code_information":[{"code":"4900111","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2371.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W BIOPSY","code_information":[{"code":"4900120","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5922.75,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY SUBMUCOUS INJ","code_information":[{"code":"4900121","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1536.5,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W COLONIC STENT","code_information":[{"code":"4900122","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":7677.5,"setting":"both","billing_class":"facility"}]},{"description":"ESD W/ENDOSCOPY OR COLONOSCOPY","code_information":[{"code":"4900130","type":"CDM"},{"code":"750","type":"RC"},{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"gross_charge":8708.75,"setting":"both","billing_class":"facility"},{"gross_charge":8460.0,"setting":"both","billing_class":"professional"}]},{"description":"EGD W BIOPSY","code_information":[{"code":"4900151","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3863.75,"setting":"both","billing_class":"facility"}]},{"description":"EGD W DILATORS","code_information":[{"code":"4900155","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD W BANDING","code_information":[{"code":"4900156","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD DILATATION W BALLON","code_information":[{"code":"4900160","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD W FEEDING TUBE","code_information":[{"code":"4900170","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1891.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD","code_information":[{"code":"4900180","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2279.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD W STENT PLACEMENT","code_information":[{"code":"4900181","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":6744.75,"setting":"both","billing_class":"facility"}]},{"description":"EGD REMOVAL FB","code_information":[{"code":"4900220","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD W BLEED CONTROL","code_information":[{"code":"4900230","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"EGD W POLYPECTOMY","code_information":[{"code":"4900250","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3863.75,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGUS-PH PROLONGED","code_information":[{"code":"4900420","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2080.0,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGUS-PH","code_information":[{"code":"4900430","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1498.75,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGOGASTRO-JEJUNOSCOPY","code_information":[{"code":"4900436","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2741.0,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGOGASTRO-JEJUNOSCO W DIL","code_information":[{"code":"4900437","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2741.0,"setting":"both","billing_class":"facility"}]},{"description":"MINOR NURSING PROC-MAB","code_information":[{"code":"4900441","type":"CDM"},{"code":"490","type":"RC"}],"standard_charges":[{"gross_charge":509.25,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX W FB REMOVAL","code_information":[{"code":"4900470","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1753.5,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX","code_information":[{"code":"4900480","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1586.25,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX W BIOPSY","code_information":[{"code":"4900483","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2401.5,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX W POLYPECTOMY","code_information":[{"code":"4900484","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2401.5,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX W DILATATION","code_information":[{"code":"4900490","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1753.5,"setting":"both","billing_class":"facility"}]},{"description":"PROCTOSCOPY","code_information":[{"code":"4900623","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1559.75,"setting":"both","billing_class":"facility"}]},{"description":"STENT COATED/COVERED C1874","code_information":[{"code":"4900634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.75,"setting":"both","billing_class":"facility"}]},{"description":"STENT NONCOAT/NONCOV C1876","code_information":[{"code":"4900635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.75,"setting":"both","billing_class":"facility"}]},{"description":"STENT NONCOAT/COV C1877","code_information":[{"code":"4900636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1877","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.75,"setting":"both","billing_class":"facility"}]},{"description":"PILLCAM CAPSULE ENDO","code_information":[{"code":"4901126","type":"CDM"},{"code":"750","type":"RC"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":4993.75,"setting":"both","billing_class":"facility"}]},{"description":"INSTL FCL MICROBIOTA SSP ENDO","code_information":[{"code":"4901127","type":"CDM"},{"code":"750","type":"RC"},{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.75,"setting":"both","billing_class":"facility"},{"gross_charge":128.0,"setting":"both","billing_class":"professional"}]},{"description":"INSJ SUB CAR THYTHM MNTR","code_information":[{"code":"4903285","type":"CDM"},{"code":"490","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":21193.0,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGOSCOPY W BLEED CONT","code_information":[{"code":"4943227","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2741.0,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAGOSCOPY W ABLATION","code_information":[{"code":"4943228","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2741.0,"setting":"both","billing_class":"facility"}]},{"description":"ENDO W BLEED CONT UPPER GI","code_information":[{"code":"4943255","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO W THERMAL TX UPPER GI","code_information":[{"code":"4943257","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":4067.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO W BLEED CONT DUODENUM","code_information":[{"code":"4944366","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO W ABLATION DUODENUM","code_information":[{"code":"4944369","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO W BLEED CONT ILEUM","code_information":[{"code":"4944378","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3132.5,"setting":"both","billing_class":"facility"}]},{"description":"POUCHOSCOPY","code_information":[{"code":"4944385","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1994.5,"setting":"both","billing_class":"facility"}]},{"description":"POUCHOSCOPY W BX","code_information":[{"code":"4944386","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3381.5,"setting":"both","billing_class":"facility"}]},{"description":"PROCTOSIGMOIDOSC W ABLATION","code_information":[{"code":"4945320","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3335.75,"setting":"both","billing_class":"facility"}]},{"description":"PROCTOSIGMOIDOSC W BL CONTR","code_information":[{"code":"4945321","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":3335.75,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID W BLEED CONT","code_information":[{"code":"4945334","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1559.75,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID FLEX W BLEED CONT","code_information":[{"code":"4945335","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1559.75,"setting":"both","billing_class":"facility"}]},{"description":"SIGMOID W ABLATION","code_information":[{"code":"4945339","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1559.75,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY BL CONT SPLENIC","code_information":[{"code":"4945382","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2371.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W ABLATION SPLENIC","code_information":[{"code":"4945383","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2371.25,"setting":"both","billing_class":"facility"}]},{"description":"COLONOSCOPY W BL CONT","code_information":[{"code":"4945384","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2371.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 2 VISIT NEW PT","code_information":[{"code":"5119202","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 3 VISIT NEW PT","code_information":[{"code":"5119203","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 4 VISIT NEW PT","code_information":[{"code":"5119204","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 5 VISIT NEW PT","code_information":[{"code":"5119205","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 3 VISIT EST PT","code_information":[{"code":"5119213","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 4 VISIT EST PT","code_information":[{"code":"5119214","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 5 VISIT EST PT","code_information":[{"code":"5119215","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 1 VISIT EST PT","code_information":[{"code":"5199211","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 2 VISIT EST PT","code_information":[{"code":"5199212","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.25,"setting":"both","billing_class":"facility"}]},{"description":"ER NONCORP IMMUNIZATION ADMIN","code_information":[{"code":"5290471","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"setting":"both","billing_class":"facility"}]},{"description":"ER NONCORP IV THERAPY 1ST HR","code_information":[{"code":"5296365","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.5,"setting":"both","billing_class":"facility"}]},{"description":"OSTEO MANIPULATION 3-4 REG","code_information":[{"code":"5398926","type":"CDM"},{"code":"530","type":"RC"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL I VISIT EST PT-ANTICOAG","code_information":[{"code":"5499211","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.75,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD WO CONTR","code_information":[{"code":"6100020","type":"CDM"},{"code":"614","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD W CONTR","code_information":[{"code":"6100021","type":"CDM"},{"code":"614","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD W/WO CONTR","code_information":[{"code":"6100022","type":"CDM"},{"code":"614","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXTR JOINT WO CONT RT","code_information":[{"code":"6100031","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":4519.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI LWR EXTR JOINT W CONT RT","code_information":[{"code":"6100032","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4538.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI LWR EXTR JOINT W/WO CON RT","code_information":[{"code":"6100033","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4765.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI BREAST W/WO CONTR BIL","code_information":[{"code":"6100039","type":"CDM"},{"code":"610","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":4451.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI BREAST WO CONTR BIL","code_information":[{"code":"6100041","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":4238.75,"setting":"both","billing_class":"facility"}]},{"description":"MRI BREAST WO CONT LT","code_information":[{"code":"6100045","type":"CDM"},{"code":"610","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":3776.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI BREAST WO CONT RT","code_information":[{"code":"6100050","type":"CDM"},{"code":"610","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":3776.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI BONE MARROW BLOOD SUPPLY","code_information":[{"code":"6100052","type":"CDM"},{"code":"614","type":"RC"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":4113.75,"setting":"both","billing_class":"facility"}]},{"description":"MRI BREAST W/WO CONTR LT","code_information":[{"code":"6100053","type":"CDM"},{"code":"610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI BRAIN W CONTR","code_information":[{"code":"6100057","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI QUANT ANLYS BRAIN W/DX","code_information":[{"code":"6100059","type":"CDM"},{"code":"611","type":"RC"},{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"facility"},{"gross_charge":223.5,"setting":"both","billing_class":"professional"}]},{"description":"MRI BREAST W/WO CONTR RT","code_information":[{"code":"6100061","type":"CDM"},{"code":"610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI CHEST WO CONTR","code_information":[{"code":"6100070","type":"CDM"},{"code":"614","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST W CONTR","code_information":[{"code":"6100071","type":"CDM"},{"code":"614","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"},{"gross_charge":4172.5,"setting":"both","billing_class":"professional"}]},{"description":"MRI CHEST W/WO CONTR","code_information":[{"code":"6100072","type":"CDM"},{"code":"614","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"},{"gross_charge":4470.75,"setting":"both","billing_class":"professional"}]},{"description":"MRI CERVICAL SPINE W/WO CONTR","code_information":[{"code":"6100090","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"},{"gross_charge":4470.75,"setting":"both","billing_class":"professional"}]},{"description":"MRI CERVICAL SPINE W CONTR","code_information":[{"code":"6100100","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI CERVICAL SPINE WO CONTR","code_information":[{"code":"6100110","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPR EXTR JNT WO CONTR RT","code_information":[{"code":"6100131","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPER EXTR JNT W CONTR RT","code_information":[{"code":"6100132","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5480.75,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPR EXTR JNT W/WO CONT RT","code_information":[{"code":"6100133","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPER EXTR JNT WO CONTR LT","code_information":[{"code":"6100134","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI UPPER EXTR JNT W CONTR LT","code_information":[{"code":"6100135","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5480.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI UPPR EXTR JNT W/WO CONT LT","code_information":[{"code":"6100136","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI ORBIT/FC/NECK WO CONTR","code_information":[{"code":"6100160","type":"CDM"},{"code":"614","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXTR WO CONTR RT","code_information":[{"code":"6100161","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI LWR EXTR W CONTR RT","code_information":[{"code":"6100162","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI LWR EXTR W/WO CONT RT","code_information":[{"code":"6100163","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI LWR EXTR WO CONTR LT","code_information":[{"code":"6100164","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI LWR EXTR W CONTR LT","code_information":[{"code":"6100165","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI LWR EXTR W/WO CONT LT","code_information":[{"code":"6100166","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI UPPER EXTR WO CONTR RT","code_information":[{"code":"6100171","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPER EXTR W CONTR RT","code_information":[{"code":"6100172","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPER EXTR W/WO CONTR RT","code_information":[{"code":"6100173","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI UPPER EXTR WO CONTR LT","code_information":[{"code":"6100174","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI UPPER EXTR W CONTR LT","code_information":[{"code":"6100175","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI UPPER EXTR W/WO CONTR LT","code_information":[{"code":"6100176","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI BRAIN W/WO CONTR","code_information":[{"code":"6100190","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":6013.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN WO CONTR","code_information":[{"code":"6100210","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXTR JOINT WO CONT BIL","code_information":[{"code":"6100212","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":6482.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"MRI LWR EXTR JOINT W CONT BIL","code_information":[{"code":"6100213","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":6806.25,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"MRI LWR EXTR JOINT WO CONT LT","code_information":[{"code":"6100218","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":4519.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI LWR EXTR JOINT W CONT LT","code_information":[{"code":"6100219","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4538.75,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI LWR EXTR JNT W/WO CON BIL","code_information":[{"code":"6100230","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":7147.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"MRI LWR EXTR JOINT W/WO CON LT","code_information":[{"code":"6100236","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4765.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI LUMBAR SPINE W/WO CONTR","code_information":[{"code":"6100310","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":6003.25,"setting":"both","billing_class":"facility"}]},{"description":"MRI LUMBAR SPINE W CONTR","code_information":[{"code":"6100320","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI LUMBAR SPINE WO CONTR","code_information":[{"code":"6100321","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI GUIDANCE FOR NEEDLE PL RT","code_information":[{"code":"6100365","type":"CDM"},{"code":"610","type":"RC"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRI GUIDANCE FOR NEEDLE PL LT","code_information":[{"code":"6100366","type":"CDM"},{"code":"610","type":"RC"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRI ORBIT/FC/NK W/WO CONTR","code_information":[{"code":"6100392","type":"CDM"},{"code":"610","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":6461.75,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS W CONTR","code_information":[{"code":"6100410","type":"CDM"},{"code":"614","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS WO CONTR","code_information":[{"code":"6100411","type":"CDM"},{"code":"614","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS W/WO CONTR","code_information":[{"code":"6100412","type":"CDM"},{"code":"614","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRI TEMPOROMANDIBULAR JOINT(S)","code_information":[{"code":"6100490","type":"CDM"},{"code":"614","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":3739.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI THORACIC SPINE W/WO CONTR","code_information":[{"code":"6100510","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRI THORACIC SPINE W CONTR","code_information":[{"code":"6100520","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI THORACIC SPINE WO CONTR","code_information":[{"code":"6100530","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI NEUROGRAPHY","code_information":[{"code":"6100532","type":"CDM"},{"code":"610","type":"RC"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.75,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD WO CONTR","code_information":[{"code":"6101011","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD W/WO CONTR","code_information":[{"code":"6101012","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD W  CONTR","code_information":[{"code":"6101013","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA CAROT/NECK WO CONTR","code_information":[{"code":"6101021","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA CAROT/NECK W CONTR","code_information":[{"code":"6101022","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA CAROT/NECK W/WO CONTR","code_information":[{"code":"6101023","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRA CHEST W/WO CONTR","code_information":[{"code":"6101030","type":"CDM"},{"code":"618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3107.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA CHEST WO CONTR","code_information":[{"code":"6101031","type":"CDM"},{"code":"618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2692.75,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD WO CONTR","code_information":[{"code":"6101041","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD W CONTR","code_information":[{"code":"6101042","type":"CDM"},{"code":"615","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD W/WO CONTR","code_information":[{"code":"6101043","type":"CDM"},{"code":"615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRA UPPER EXTR W CONT RT","code_information":[{"code":"6101086","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRA UPPER EXTR WO CONT RT","code_information":[{"code":"6101087","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRA UPPER EXTR W CONT LT","code_information":[{"code":"6101088","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA UPPER EXTR WO CONT LT","code_information":[{"code":"6101089","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA UPPER EXTR W/WO CONT LT","code_information":[{"code":"6101090","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA LWR EXTR W CONT LT","code_information":[{"code":"6101091","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA LWR EXTR WO CONT LT","code_information":[{"code":"6101092","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA LWR EXTR W/WO CONT LT","code_information":[{"code":"6101093","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"MRA PELVIS W CONTR","code_information":[{"code":"6101094","type":"CDM"},{"code":"618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA PELVIS WO CONTR","code_information":[{"code":"6101095","type":"CDM"},{"code":"618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","billing_class":"facility"}]},{"description":"MRA PELVIS W/WO CONTR","code_information":[{"code":"6101096","type":"CDM"},{"code":"618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","billing_class":"facility"}]},{"description":"MRA UPPER EXTR W/WO CONT RT","code_information":[{"code":"6101097","type":"CDM"},{"code":"618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRA LWR EXTR W CONTR RT","code_information":[{"code":"6101098","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5483.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRA LWR EXTR WO CONTR RT","code_information":[{"code":"6101099","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"MRA LWR EXTR W/WO CONT RT","code_information":[{"code":"6101100","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5874.25,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"TRAUMA ACTIVATE W/NOTIFY & CC","code_information":[{"code":"6830000","type":"CDM"},{"code":"684","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":6767.25,"setting":"both","billing_class":"facility"}]},{"description":"TRAUMA ACT W/NOTIFY W/O CC","code_information":[{"code":"6830003","type":"CDM"},{"code":"684","type":"RC"}],"standard_charges":[{"gross_charge":6767.25,"setting":"both","billing_class":"facility"}]},{"description":"PACU ADDL 15 MINS","code_information":[{"code":"7100011","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":454.5,"setting":"both","billing_class":"facility"}]},{"description":"PACU 1-30 MINS","code_information":[{"code":"7100012","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1239.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDO STEPDOWN REC 0-30M SDS","code_information":[{"code":"7100015","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"facility"}]},{"description":"ENDO STEPDOWN REC ADDL 15M SDS","code_information":[{"code":"7100016","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"setting":"both","billing_class":"facility"}]},{"description":"RECOVERY ROOM OB 31-60 MINS","code_information":[{"code":"7100110","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1624.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDO STEPDOWN REC 0-30M","code_information":[{"code":"7100111","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"setting":"both","billing_class":"facility"}]},{"description":"ENDO STEPDOWN REC ADDL 15M","code_information":[{"code":"7100112","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"setting":"both","billing_class":"facility"}]},{"description":"LABOR & DELIVERY CHARGE","code_information":[{"code":"7200050","type":"CDM"},{"code":"722","type":"RC"}],"standard_charges":[{"gross_charge":9011.75,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOR COLLECTION OF SPEC OB","code_information":[{"code":"7219612","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.75,"setting":"both","billing_class":"facility"}]},{"description":"CIRCUMCISION","code_information":[{"code":"7230010","type":"CDM"},{"code":"723","type":"RC"}],"standard_charges":[{"gross_charge":695.75,"setting":"both","billing_class":"facility"}]},{"description":"CIRCUMCISION W/REGIONAL BLOCK","code_information":[{"code":"7230012","type":"CDM"},{"code":"360","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":4632.75,"setting":"both","billing_class":"facility"}]},{"description":"INSERT BLADD CATH FOLEY OB/3N","code_information":[{"code":"7251702","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"setting":"both","billing_class":"facility"}]},{"description":"OXYTOCIN STRESS-OB","code_information":[{"code":"7259020","type":"CDM"},{"code":"920","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.5,"setting":"both","billing_class":"facility"}]},{"description":"ANTEPARTUM MANIPULATION-OB","code_information":[{"code":"7259021","type":"CDM"},{"code":"361","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":3565.75,"setting":"both","billing_class":"facility"}]},{"description":"NON STRESS TEST-OB","code_information":[{"code":"7259025","type":"CDM"},{"code":"920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.75,"setting":"both","billing_class":"facility"}]},{"description":"VAGINAL DELIVERY ONLY-OB","code_information":[{"code":"7259026","type":"CDM"},{"code":"720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":7109.75,"setting":"both","billing_class":"facility"}]},{"description":"CESAREAN DELIVERY ONLY-OB","code_information":[{"code":"7259027","type":"CDM"},{"code":"360","type":"RC"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":9730.5,"setting":"both","billing_class":"facility"}]},{"description":"DELIVERY OF PLACENTA-OB","code_information":[{"code":"7259028","type":"CDM"},{"code":"360","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":6776.75,"setting":"both","billing_class":"facility"}]},{"description":"INSERT CERVICAL DILATOR-OB","code_information":[{"code":"7259200","type":"CDM"},{"code":"361","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-3N/OB","code_information":[{"code":"7290471","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IV THERAPY HYDRATION INI-OB/3N","code_information":[{"code":"7296360","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.75,"setting":"both","billing_class":"facility"}]},{"description":"IV THERAPY HYDRATION ADD-OB/3N","code_information":[{"code":"7296361","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.75,"setting":"both","billing_class":"facility"}]},{"description":"IV THERAPY DIAG ADDL HR-OB/3N","code_information":[{"code":"7296366","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.75,"setting":"both","billing_class":"facility"}]},{"description":"IV INFUSION ADDL DRUG-OB/3N","code_information":[{"code":"7296367","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"setting":"both","billing_class":"facility"}]},{"description":"IV THERAPY CONCURRENT-OB/3N","code_information":[{"code":"7296368","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ THER/PROPH/DIA SC/IM-OB/3N","code_information":[{"code":"7296372","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-OB/3N","code_information":[{"code":"7296374","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DR-OB/3N","code_information":[{"code":"7296375","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADD DR-OB/3N","code_information":[{"code":"7296376","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ANTI-NEOPL ADMIN-OB/3N","code_information":[{"code":"7296401","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 1 W/CONTRACTIONS W/S4005","code_information":[{"code":"7299000","type":"CDM"},{"code":"729","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 2 W/CONTRACTIONS W/S4005","code_information":[{"code":"7299001","type":"CDM"},{"code":"729","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 3 W/CONTRACTIONS W/S4005","code_information":[{"code":"7299002","type":"CDM"},{"code":"729","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 4 W/CONTRACTIONS W/S4005","code_information":[{"code":"7299003","type":"CDM"},{"code":"729","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 5 W/CONTRACTIONS W/S4005","code_information":[{"code":"7299004","type":"CDM"},{"code":"729","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVEL 1 W/CONTRACTIONS-OB","code_information":[{"code":"7299005","type":"CDM"},{"code":"729","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.5,"setting":"both","billing_class":"facility"},{"gross_charge":1042.75,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 2 W/CONTRACTIONS-OB","code_information":[{"code":"7299006","type":"CDM"},{"code":"729","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.75,"setting":"both","billing_class":"facility"},{"gross_charge":1139.25,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 3 W/CONTRACTIONS-OB","code_information":[{"code":"7299007","type":"CDM"},{"code":"729","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.5,"setting":"both","billing_class":"facility"},{"gross_charge":1244.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 4 W/CONTRACTIONS-OB","code_information":[{"code":"7299008","type":"CDM"},{"code":"729","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"setting":"both","billing_class":"facility"},{"gross_charge":1359.0,"setting":"both","billing_class":"professional"}]},{"description":"LEVEL 5 W/CONTRACTIONS-OB","code_information":[{"code":"7299009","type":"CDM"},{"code":"729","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"setting":"both","billing_class":"facility"},{"gross_charge":1497.0,"setting":"both","billing_class":"professional"}]},{"description":"ECHO 2D W/O DOPPLER (BL&WHITE)","code_information":[{"code":"7300010","type":"CDM"},{"code":"480","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.5,"setting":"both","billing_class":"facility"}]},{"description":"MYOCARDIAL STRAIN IMAGING","code_information":[{"code":"7300011","type":"CDM"},{"code":"483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"setting":"both","billing_class":"facility"}]},{"description":"3D RENDER NOT REQU POSTPROCESS","code_information":[{"code":"7300012","type":"CDM"},{"code":"400","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"setting":"both","billing_class":"facility"}]},{"description":"EKG TRACING","code_information":[{"code":"7300020","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.75,"setting":"both","billing_class":"facility"}]},{"description":"ECG MONITOR/REC 48 HRS","code_information":[{"code":"7300040","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1152.0,"setting":"both","billing_class":"facility"},{"gross_charge":876.5,"setting":"both","billing_class":"professional"}]},{"description":"EKG UP TO 48 HRS REC","code_information":[{"code":"7300041","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.75,"setting":"both","billing_class":"facility"},{"gross_charge":256.75,"setting":"both","billing_class":"professional"}]},{"description":"EKG >48HRS TO 7 DAYS REC","code_information":[{"code":"7300042","type":"CDM"},{"code":"731","type":"RC"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.5,"setting":"both","billing_class":"facility"},{"gross_charge":77.75,"setting":"both","billing_class":"professional"}]},{"description":"EKG >7DAYS TO 15 DAYS REC","code_information":[{"code":"7300043","type":"CDM"},{"code":"731","type":"RC"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"setting":"both","billing_class":"facility"},{"gross_charge":127.5,"setting":"both","billing_class":"professional"}]},{"description":"HOLTER SCAN-MHC","code_information":[{"code":"7300050","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.5,"setting":"both","billing_class":"facility"},{"gross_charge":859.25,"setting":"both","billing_class":"professional"}]},{"description":"EVENT MONITOR 30 DAY ECG","code_information":[{"code":"7300072","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1031.75,"setting":"both","billing_class":"facility"}]},{"description":"EEG ASLEEP AND AWAKE","code_information":[{"code":"7400010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2249.75,"setting":"both","billing_class":"facility"}]},{"description":"EEG AWAKE AND DROWSY","code_information":[{"code":"7400011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1923.5,"setting":"both","billing_class":"facility"},{"gross_charge":1831.75,"setting":"both","billing_class":"professional"}]},{"description":"EEG COMA OR SLEEP ONLY","code_information":[{"code":"7400014","type":"CDM"},{"code":"740","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG SET UP/EDUCATION","code_information":[{"code":"7400020","type":"CDM"},{"code":"740","type":"RC"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 2-12H UNMNTR","code_information":[{"code":"7400021","type":"CDM"},{"code":"740","type":"RC"},{"code":"95705","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 2-12H INTRMT MNTR","code_information":[{"code":"7400022","type":"CDM"},{"code":"740","type":"RC"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 2-12H CONT MNTR","code_information":[{"code":"7400023","type":"CDM"},{"code":"740","type":"RC"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 12-26H UNMNTR","code_information":[{"code":"7400024","type":"CDM"},{"code":"740","type":"RC"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 12-26H INTMT MNTR","code_information":[{"code":"7400025","type":"CDM"},{"code":"740","type":"RC"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG WO VIDEO 12-26H CONT MNTR","code_information":[{"code":"7400026","type":"CDM"},{"code":"740","type":"RC"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 2-12H UNMNTR","code_information":[{"code":"7400027","type":"CDM"},{"code":"740","type":"RC"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 2-12H INTRMT MNTR","code_information":[{"code":"7400028","type":"CDM"},{"code":"740","type":"RC"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 2-12H CONT MNTR","code_information":[{"code":"7400029","type":"CDM"},{"code":"740","type":"RC"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.75,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 12-26H UNMNTR","code_information":[{"code":"7400031","type":"CDM"},{"code":"740","type":"RC"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 12-26H INTRMT MNTR","code_information":[{"code":"7400032","type":"CDM"},{"code":"740","type":"RC"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.5,"setting":"both","billing_class":"facility"}]},{"description":"EEG W VIDEO 12-26H CONT MNTR","code_information":[{"code":"7400033","type":"CDM"},{"code":"740","type":"RC"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":2493.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG DIGITAL ANALYSIS","code_information":[{"code":"7400035","type":"CDM"},{"code":"740","type":"RC"},{"code":"95957","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.5,"setting":"both","billing_class":"facility"}]},{"description":"HOME SLEEP TEST-MMA BILLING","code_information":[{"code":"7400398","type":"CDM"},{"code":"740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.5,"setting":"both","billing_class":"professional"}]},{"description":"HOME SLEEP TEST","code_information":[{"code":"7400399","type":"CDM"},{"code":"740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.0,"setting":"both","billing_class":"facility"},{"gross_charge":997.0,"setting":"both","billing_class":"professional"}]},{"description":"EEG EXT MONITORING; 41-60MIN","code_information":[{"code":"7400812","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.25,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXT MONITORING; 61-119MIN","code_information":[{"code":"7400813","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":2085.25,"setting":"both","billing_class":"facility"}]},{"description":"POLYSOM 6/> YRS 4/> PARAM","code_information":[{"code":"7402010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2378.25,"setting":"both","billing_class":"facility"}]},{"description":"POLYSOM 6/>YRS W/CPAP 4/>PARAM","code_information":[{"code":"7402011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":2378.25,"setting":"both","billing_class":"facility"}]},{"description":"MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"7402060","type":"CDM"},{"code":"740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDO PRE-OP PER OCC SDS","code_information":[{"code":"7500100","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":392.0,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL II 0-30M SDS","code_information":[{"code":"7500101","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":4902.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL II ADDL 15M SDS","code_information":[{"code":"7500102","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2451.0,"setting":"both","billing_class":"facility"}]},{"description":"ENDOSCOPY SET UP SDS","code_information":[{"code":"7500103","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":378.0,"setting":"both","billing_class":"facility"}]},{"description":"EMER ENDO LEVEL II 0-30M SDS","code_information":[{"code":"7500104","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5266.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER ENDO LEVEL II ADL 15M SDS","code_information":[{"code":"7500105","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2633.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDO PRE-OP PER OCC","code_information":[{"code":"7500110","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":384.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL II 0-30MINS","code_information":[{"code":"7500111","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":4902.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL II ADDL 15M","code_information":[{"code":"7500112","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2464.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDOSCOPY SET UP MAB","code_information":[{"code":"7500113","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":371.5,"setting":"both","billing_class":"facility"}]},{"description":"EMER ENDO LEVEL II 0-30MINS","code_information":[{"code":"7500114","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5266.25,"setting":"both","billing_class":"facility"}]},{"description":"EMER ENDO LEVEL II ADDL 15M","code_information":[{"code":"7500115","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2633.25,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL III 0-30M SDS","code_information":[{"code":"7500116","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5303.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL III ADDL 15M SDS","code_information":[{"code":"7500117","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2652.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL III 0-30MINS","code_information":[{"code":"7500118","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":5304.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LEVEL III ADDL 15M","code_information":[{"code":"7500119","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2666.5,"setting":"both","billing_class":"facility"}]},{"description":"ENTEROSCOPY","code_information":[{"code":"7500125","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2878.25,"setting":"both","billing_class":"facility"}]},{"description":"ILESOSCOPY","code_information":[{"code":"7500130","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1457.75,"setting":"both","billing_class":"facility"}]},{"description":"PEG TUBE REPLACEMENT BY ENDOSC","code_information":[{"code":"7500200","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2648.75,"setting":"both","billing_class":"facility"}]},{"description":"PEG TUBE CHANGE","code_information":[{"code":"7500201","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":1365.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEFECT CLOSURE GI TRACT","code_information":[{"code":"7500202","type":"CDM"},{"code":"360","type":"RC"},{"code":"C9901","type":"HCPCS"}],"standard_charges":[{"gross_charge":11098.25,"setting":"both","billing_class":"facility"}]},{"description":"PEG TUBE INSERT","code_information":[{"code":"7500205","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2647.5,"setting":"both","billing_class":"facility"}]},{"description":"PEG TUBE REMOVAL BY GASTROSCOP","code_information":[{"code":"7500210","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2093.25,"setting":"both","billing_class":"facility"}]},{"description":"PEG TUBE REM BY INCIS-IP ONLY","code_information":[{"code":"7500211","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":7253.5,"setting":"both","billing_class":"facility"}]},{"description":"REMOVAL TUNNELED CV CATH","code_information":[{"code":"7501124","type":"CDM"},{"code":"490","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":2841.25,"setting":"both","billing_class":"facility"}]},{"description":"BRAVO PH CAPSULE TEST","code_information":[{"code":"7501127","type":"CDM"},{"code":"750","type":"RC"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2488.5,"setting":"both","billing_class":"facility"}]},{"description":"PATENCY (AGILE) CAPSULE","code_information":[{"code":"7501134","type":"CDM"},{"code":"750","type":"RC"},{"code":"91299","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.75,"setting":"both","billing_class":"facility"}]},{"description":"BONE MARROW ASPIRATION","code_information":[{"code":"7508220","type":"CDM"},{"code":"361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.5,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHOSCOPY DIAG","code_information":[{"code":"7543200","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":2094.25,"setting":"both","billing_class":"facility"}]},{"description":"OBSERVATION PER HR","code_information":[{"code":"7600022","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.75,"setting":"both","billing_class":"facility"}]},{"description":"OBSERVATION-1ST HR DIR ADM","code_information":[{"code":"7600024","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.75,"setting":"both","billing_class":"facility"}]},{"description":"CHILDBIRTH CLASS EACH","code_information":[{"code":"7700101","type":"CDM"},{"code":"942","type":"RC"},{"code":"S9442","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.75,"setting":"both","billing_class":"facility"}]},{"description":"BREAST FEEDING CLASS CHG","code_information":[{"code":"7700112","type":"CDM"},{"code":"942","type":"RC"},{"code":"S9442","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"facility"}]},{"description":"INFANT CARE CLASS CHG","code_information":[{"code":"7700116","type":"CDM"},{"code":"942","type":"RC"},{"code":"S9442","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"facility"}]},{"description":"HEMODIALYSIS","code_information":[{"code":"8000200","type":"CDM"},{"code":"801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.25,"setting":"both","billing_class":"facility"}]},{"description":"DIALYSIS UNSCH OUTPATIENT","code_information":[{"code":"8000206","type":"CDM"},{"code":"829","type":"RC"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":1454.0,"setting":"both","billing_class":"facility"}]},{"description":"PERITONEAL DIALYSIS 1 EVAL","code_information":[{"code":"8090945","type":"CDM"},{"code":"802","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.75,"setting":"both","billing_class":"facility"}]},{"description":"DOPPLER PVR U/L EXT ART 3LEVEL","code_information":[{"code":"9203220","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.5,"setting":"both","billing_class":"facility"}]},{"description":"DOPPLER PVR U/L EXT ART 2LEVEL","code_information":[{"code":"9203221","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.25,"setting":"both","billing_class":"facility"}]},{"description":"DOPPLER CAROTID BILATERAL","code_information":[{"code":"9203230","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.25,"setting":"both","billing_class":"facility"}]},{"description":"DOPPLER CAROTID UNILATERAL","code_information":[{"code":"9203231","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-PCU","code_information":[{"code":"9400002","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-INF","code_information":[{"code":"9400003","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-2N","code_information":[{"code":"9400005","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-LTC","code_information":[{"code":"9400006","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-AC","code_information":[{"code":"9400007","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-3S","code_information":[{"code":"9400008","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMIN-ICU","code_information":[{"code":"9400009","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-INF","code_information":[{"code":"9400010","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-INF","code_information":[{"code":"9400011","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-PCU","code_information":[{"code":"9400012","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-4S","code_information":[{"code":"9400013","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-4W","code_information":[{"code":"9400014","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB-XXXX INFUSION-4S","code_information":[{"code":"9400015","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB-XXXX INFUSION-4W","code_information":[{"code":"9400016","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB-XXXX INFUSION-ICU","code_information":[{"code":"9400017","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLAN AND ETESEV INFUSION-4S","code_information":[{"code":"9400020","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-3S","code_information":[{"code":"9400100","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-2N","code_information":[{"code":"9400101","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-ICU","code_information":[{"code":"9400102","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH INIT-AC","code_information":[{"code":"9400103","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.5,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-ICU","code_information":[{"code":"9400104","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-AC","code_information":[{"code":"9400105","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-PCU","code_information":[{"code":"9400106","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-2N","code_information":[{"code":"9400107","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-4S","code_information":[{"code":"9400108","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-4W","code_information":[{"code":"9400109","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-3S","code_information":[{"code":"9400111","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-INF","code_information":[{"code":"9400160","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-2N","code_information":[{"code":"9400161","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-3S","code_information":[{"code":"9400162","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-AC","code_information":[{"code":"9400163","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-ICU","code_information":[{"code":"9400164","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-PCU","code_information":[{"code":"9400166","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"DIAG INJ IV PUSH ADDL DRUG-4S","code_information":[{"code":"9400167","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.75,"setting":"both","billing_class":"facility"}]},{"description":"PRE DIABETES COUNSELING 30 MIN","code_information":[{"code":"9400190","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":35.5,"setting":"both","billing_class":"facility"}]},{"description":"DIABETES GROUP CLASS PER 1/2HR","code_information":[{"code":"9400202","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","billing_class":"facility"}]},{"description":"CONT GLUCOSE MONITOR-DIAB ED","code_information":[{"code":"9400203","type":"CDM"},{"code":"942","type":"RC"},{"code":"95250","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.25,"setting":"both","billing_class":"facility"}]},{"description":"DIAB EDUC INDIV ASSESSMENT 30M","code_information":[{"code":"9400241","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","billing_class":"facility"}]},{"description":"PHONE DIABETES GRP PER 1/2HR","code_information":[{"code":"9400250","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE NURSE-DIAB ED PER 30MIN","code_information":[{"code":"9400251","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE DIAB ED IND ASSESS 30MIN","code_information":[{"code":"9400252","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE DIETARY DIAB PER 30MIN","code_information":[{"code":"9400253","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE MED NUTR IND INT 15MIN","code_information":[{"code":"9400254","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE MED NUTR IND SUBSQ 15M","code_information":[{"code":"9400255","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE MED NUTRITION GRP 30MIN","code_information":[{"code":"9400256","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"PHONE MED NUTR IND 15M,2ND REF","code_information":[{"code":"9400257","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL DIABETES GRP PER 1/2HR","code_information":[{"code":"9400260","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.75,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL NURSE-DIAB ED PER 30M","code_information":[{"code":"9400261","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL DIAB ED IND ASSESS 30M","code_information":[{"code":"9400262","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL DIETARY DIAB PER 30MIN","code_information":[{"code":"9400263","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL MED NUTR IND INT 15MIN","code_information":[{"code":"9400264","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL MED NUTR IND SUBSQ 15M","code_information":[{"code":"9400265","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL MED NUTRITION GRP 30M","code_information":[{"code":"9400266","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"VIRTUAL MED NUTR IND 15M,2ND R","code_information":[{"code":"9400267","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","modifiers":"GT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GT: Via interactive audio and video telecommunication systems"}]},{"description":"DIETARY DIAB PER 30MIN","code_information":[{"code":"9400276","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"setting":"both","billing_class":"facility"}]},{"description":"DIETARY ASSESSMENT","code_information":[{"code":"9400280","type":"CDM"},{"code":"940","type":"RC"}],"standard_charges":[{"gross_charge":325.25,"setting":"both","billing_class":"facility"}]},{"description":"CHOLESTEROL COUNSELING 30MIN","code_information":[{"code":"9400290","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":35.5,"setting":"both","billing_class":"facility"}]},{"description":"CARDIAC REHAB PHASE II","code_information":[{"code":"9400300","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.75,"setting":"both","billing_class":"facility"}]},{"description":"CARDIAC REHAB PHASE I","code_information":[{"code":"9400305","type":"CDM"},{"code":"943","type":"RC"}],"standard_charges":[{"gross_charge":244.25,"setting":"both","billing_class":"facility"}]},{"description":"CARDIAC REHAB PHASE III","code_information":[{"code":"9400310","type":"CDM"},{"code":"943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-3S","code_information":[{"code":"9400447","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-LTC","code_information":[{"code":"9400449","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-AC","code_information":[{"code":"9400450","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-INF","code_information":[{"code":"9400451","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-2N","code_information":[{"code":"9400452","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-2N","code_information":[{"code":"9400453","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-LTC","code_information":[{"code":"9400454","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-3N","code_information":[{"code":"9400455","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-4S","code_information":[{"code":"9400456","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-3S","code_information":[{"code":"9400458","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-ICU","code_information":[{"code":"9400459","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-ICU","code_information":[{"code":"9400460","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-PCU","code_information":[{"code":"9400461","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCOCCAL VACCINE ADMIN-PCU","code_information":[{"code":"9400462","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-INF","code_information":[{"code":"9400463","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-4S","code_information":[{"code":"9400464","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-FAC","code_information":[{"code":"9400465","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-PHARMACY","code_information":[{"code":"9400466","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.5,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-AC","code_information":[{"code":"9400468","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACCINE ADMIN-3N","code_information":[{"code":"9400469","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB-XXXX INFUSION 3S","code_information":[{"code":"9400523","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB-XXXX INFUSION 4S","code_information":[{"code":"9400524","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB-XXXX INFUSION ICU","code_information":[{"code":"9400525","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB-XXXX INFUSION PCU","code_information":[{"code":"9400526","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB-XXXX INFUSION 2N","code_information":[{"code":"9400527","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB INFUSION-LTC","code_information":[{"code":"9400551","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB INFUSION-4S","code_information":[{"code":"9400552","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLAN AND ETESEV INFUSION-LTC","code_information":[{"code":"9400553","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"BAMLAN AND ETESEV INFUSION-2N","code_information":[{"code":"9400554","type":"CDM"},{"code":"260","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.25,"setting":"both","billing_class":"facility"}]},{"description":"TIXAGEV AND CILGAV INJ ADM-INF","code_information":[{"code":"9400555","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"BEBTELOVIMAB INJ ADM-INF","code_information":[{"code":"9400556","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.75,"setting":"both","billing_class":"facility"}]},{"description":"MED NUTRITI INDI INT 15MIN","code_information":[{"code":"9427802","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"setting":"both","billing_class":"facility"}]},{"description":"MED NUTRITI IND SUBSEQ 15M","code_information":[{"code":"9427803","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"facility"}]},{"description":"MED NUTRITION GROUP 30MIN","code_information":[{"code":"9427804","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"setting":"both","billing_class":"facility"}]},{"description":"MED NUTRIT INDIV 15MIN,2ND REF","code_information":[{"code":"9427805","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.25,"setting":"both","billing_class":"facility"}]},{"description":"SP MNT NUTRITION INDIV 1HR","code_information":[{"code":"9427810","type":"CDM"},{"code":"990","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.25,"setting":"both","billing_class":"facility"}]},{"description":"SP MNT NUTRITION GROUP 1HR","code_information":[{"code":"9427811","type":"CDM"},{"code":"990","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"facility"}]},{"description":"TB SKIN TEST","code_information":[{"code":"9486580","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"}]},{"description":"TB SKIN TEST COMMUNITY","code_information":[{"code":"9486581","type":"CDM"},{"code":"300","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.5,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNIZATION ADMINIS ADD'L","code_information":[{"code":"9490474","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"setting":"both","billing_class":"facility"}]},{"description":"FLU SHOTS,COMMUNITY-HH","code_information":[{"code":"9490661","type":"CDM"},{"code":"771","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"setting":"both","billing_class":"facility"}]},{"description":"FLU SHOTS,COMMUNITY-MHC","code_information":[{"code":"9490662","type":"CDM"},{"code":"771","type":"RC"}],"standard_charges":[{"gross_charge":200.0,"setting":"both","billing_class":"facility"}]},{"description":"FLU SHOTS/VACC&ADMIN","code_information":[{"code":"9490663","type":"CDM"},{"code":"771","type":"RC"}],"standard_charges":[{"gross_charge":32.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO PROLONG INFUSEw/PUMP","code_information":[{"code":"9496416","type":"CDM"},{"code":"335","type":"RC"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.75,"setting":"both","billing_class":"facility"}]},{"description":"REFILL/MAINT PORTABLE PUMP","code_information":[{"code":"9496521","type":"CDM"},{"code":"940","type":"RC"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.5,"setting":"both","billing_class":"facility"}]},{"description":"PHLEBOTOMY  THERAPEUTIC","code_information":[{"code":"9499195","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.5,"setting":"both","billing_class":"facility"}]},{"description":"RE-CONSENT FEE","code_information":[{"code":"9700102","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":120.0,"setting":"both","billing_class":"facility"}]},{"description":"SITE PREP FEE AMENDMENT IRB","code_information":[{"code":"9700103","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":500.0,"setting":"both","billing_class":"facility"}]},{"description":"SITE PREP FEE RENEWAL IRB","code_information":[{"code":"9700104","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":500.0,"setting":"both","billing_class":"facility"}]},{"description":"PHARMACY CLOSE OUT FEE","code_information":[{"code":"9700105","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":600.0,"setting":"both","billing_class":"facility"}]},{"description":"PHARMACY ANNUAL FEE","code_information":[{"code":"9700106","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":950.0,"setting":"both","billing_class":"facility"}]},{"description":"DOCUMENT STORAGE","code_information":[{"code":"9700107","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"STUDY CLOSE OUT","code_information":[{"code":"9700108","type":"CDM"},{"code":"969","type":"RC"}],"standard_charges":[{"gross_charge":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"PHARMACY SET UP FEE","code_information":[{"code":"9700109","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":1500.0,"setting":"both","billing_class":"facility"}]},{"description":"SITE PREP FEE INITIAL IRB","code_information":[{"code":"9700110","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":2000.0,"setting":"both","billing_class":"facility"}]},{"description":"STUDY START UP FEE","code_information":[{"code":"9700111","type":"CDM"},{"code":"969","type":"RC"}],"standard_charges":[{"gross_charge":6000.0,"setting":"both","billing_class":"facility"}]},{"description":"SCREENING VISIT","code_information":[{"code":"9700200","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":704.0,"setting":"both","billing_class":"facility"}]},{"description":"BASELINE VISIT","code_information":[{"code":"9700201","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1143.39,"setting":"both","billing_class":"facility"}]},{"description":"MONTH 6 VISIT","code_information":[{"code":"9700202","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":707.39,"setting":"both","billing_class":"facility"}]},{"description":"MONTH 12 VISIT","code_information":[{"code":"9700203","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":707.39,"setting":"both","billing_class":"facility"}]},{"description":"MONTH 18 VISIT","code_information":[{"code":"9700204","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":707.39,"setting":"both","billing_class":"facility"}]},{"description":"MONTH 24 VISIT END OF STUDY","code_information":[{"code":"9700205","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":965.95,"setting":"both","billing_class":"facility"}]},{"description":"PREMATURE STUDY WITHDRAWAL","code_information":[{"code":"9700206","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":965.95,"setting":"both","billing_class":"facility"}]},{"description":"POST DRF ALC VISIT","code_information":[{"code":"9700207","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":773.95,"setting":"both","billing_class":"facility"}]},{"description":"OPTIONAL SERUM PREP AND SHIP","code_information":[{"code":"9700208","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"gross_charge":82.55,"setting":"both","billing_class":"facility"}]},{"description":"RECONSENT","code_information":[{"code":"9700209","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":153.6,"setting":"both","billing_class":"facility"}]},{"description":"ADMINISTRATIVE IRB FEE","code_information":[{"code":"9700210","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":525.0,"setting":"both","billing_class":"facility"}]},{"description":"AMEND PREP FOR SITE LEVEL SUB","code_information":[{"code":"9700211","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":450.0,"setting":"both","billing_class":"facility"}]},{"description":"ARCHIVING/DOCUMENT STORAGE","code_information":[{"code":"9700212","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":750.0,"setting":"both","billing_class":"facility"}]},{"description":"STUDY CLOSE OUT FEE","code_information":[{"code":"9700213","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1250.0,"setting":"both","billing_class":"facility"}]},{"description":"EARLY TERM VISIT COHORT AA","code_information":[{"code":"9700300","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1445.0,"setting":"both","billing_class":"facility"}]},{"description":"EARLY TERM VISIT COHORT A1-A5","code_information":[{"code":"9700301","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1539.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LABS PHLEB PREP SPEC","code_information":[{"code":"9700302","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":63.0,"setting":"both","billing_class":"facility"}]},{"description":"CENTRAL LABS HANDLING AND PREP","code_information":[{"code":"9700303","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"setting":"both","billing_class":"facility"}]},{"description":"WEEKLY STAFFING","code_information":[{"code":"9800000","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":8349.0,"setting":"both","billing_class":"facility"}]},{"description":"WEEKLY COURIER","code_information":[{"code":"9800001","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":1610.0,"setting":"both","billing_class":"facility"}]},{"description":"CONFERENCE ROOM RENTAL","code_information":[{"code":"9900100","type":"CDM"},{"code":"991","type":"RC"}],"standard_charges":[{"gross_charge":108.25,"setting":"both","billing_class":"facility"}]},{"description":"EQUIPMENT RENTAL","code_information":[{"code":"9900115","type":"CDM"},{"code":"994","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"facility"}]},{"description":"SIMPLE FORMS (1-2PG ONLY)-MMA","code_information":[{"code":"9900500","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"setting":"both","billing_class":"professional"}]},{"description":"MODERATE FORMS (3-5 PAGES)-MMA","code_information":[{"code":"9900501","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"setting":"both","billing_class":"professional"}]},{"description":"COMPLEX FORMS (6 AND UP)-MMA","code_information":[{"code":"9900502","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"setting":"both","billing_class":"professional"}]},{"description":"1 PENNY CHG FOR POSTING-MMA","code_information":[{"code":"9999991","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","billing_class":"professional"}]},{"description":"1 PENNY CHG FOR POSTING-MHC","code_information":[{"code":"9999992","type":"CDM"},{"code":"511","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","billing_class":"facility"}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"minimum":53550.35,"maximum":101047.47,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53550.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101047.47,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91400.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":8780.05,"maximum":12256.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8780.05,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12256.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":9078.84,"maximum":9640.01,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9078.84,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9640.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":6492.75,"maximum":14404.24,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6492.75,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8503.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12345.31,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14404.24,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11994.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":4132.92,"maximum":17212.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7555.28,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6492.75,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7301.64,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17212.73,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5565.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6759.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7567.7,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4132.92,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":5267.32,"maximum":11235.94,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11235.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5470.47,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5267.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cva And Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":4721.96,"maximum":4721.96,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4721.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":12507.12,"maximum":12507.12,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12507.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":7622.07,"maximum":7635.32,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7635.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7622.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":10645.37,"maximum":10645.37,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10645.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":5115.19,"maximum":7367.62,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5115.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7367.62,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7367.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":4852.42,"maximum":4852.42,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4852.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":5713.32,"maximum":5713.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5713.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"minimum":8246.49,"maximum":9075.02,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9075.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8246.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":15800.98,"maximum":15800.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15800.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":8088.29,"maximum":8088.29,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8088.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":12061.93,"maximum":12061.93,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12061.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":5797.43,"maximum":5797.43,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5797.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":5811.66,"maximum":7303.03,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5811.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7303.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":8299.02,"maximum":15397.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14861.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13239.12,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15397.03,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8299.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":1608.0,"maximum":8264.78,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8264.78,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6587.46,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1642.33,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6582.51,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5794.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":6162.37,"maximum":6162.37,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6162.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":4233.98,"maximum":4233.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4233.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":8496.29,"maximum":8496.29,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8496.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":11119.13,"maximum":11119.13,"setting":"inpatient","payers_information":[{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11119.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":5317.87,"maximum":5317.87,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5317.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":27821.82,"maximum":27821.82,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27821.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":6634.68,"maximum":13901.49,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10000.29,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13901.49,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9946.02,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6634.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9904.71,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10619.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":4364.7,"maximum":4364.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4364.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":6005.36,"maximum":23967.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11897.58,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9691.04,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23967.32,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18682.55,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9411.07,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6005.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11877.75,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11880.25,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":8333.1,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10334.54,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11889.75,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6005.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10312.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":4702.74,"maximum":14236.65,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14236.65,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":6722.59,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4702.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5502.29,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5310.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":4911.14,"maximum":8922.86,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8922.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4911.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5908.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":1590.32,"maximum":13791.14,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10838.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13791.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12161.7,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1590.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":8495.89,"maximum":8495.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8495.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":11059.46,"maximum":11709.53,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11059.46,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11709.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":6739.44,"maximum":6739.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6739.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":9316.94,"maximum":9316.94,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9316.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":1527.46,"maximum":10908.64,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10908.64,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1527.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":1500.0,"maximum":17718.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5008.6,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8388.2,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15191.8,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17718.58,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8794.93,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5096.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8752.42,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6821.63,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7751.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":5350.7,"maximum":7788.24,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7788.24,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5350.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":5389.23,"maximum":10101.96,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6174.48,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10101.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5389.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":6410.4,"maximum":6410.4,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6410.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":4464.96,"maximum":13878.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4711.86,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9197.85,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13878.32,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7961.05,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9394.18,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5576.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9388.32,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9394.1,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4543.71,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4846.82,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4464.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":1791.97,"maximum":9289.24,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6146.6,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9289.24,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1791.97,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3749.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5992.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5996.47,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3749.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":6302.26,"maximum":6302.26,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6302.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":11618.04,"maximum":13519.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11618.04,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13519.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":10551.23,"maximum":11591.62,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11591.62,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10551.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":1500.0,"maximum":9140.48,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9140.48,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7708.08,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5857.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":3791.46,"maximum":9468.71,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9468.71,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5379.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7935.32,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3791.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":4634.68,"maximum":4634.68,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4634.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":9799.2,"maximum":9799.2,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9799.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":27195.89,"maximum":47369.96,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47369.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45361.87,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":27195.89,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":18663.36,"maximum":33262.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18704.96,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18663.36,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33262.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18663.36,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19286.58,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19935.18,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20591.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":32932.0,"maximum":32932.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32932.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":3692.66,"maximum":9540.91,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9540.91,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6128.45,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3692.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":2723.63,"maximum":15068.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9908.38,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9102.77,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12180.13,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15068.83,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9023.77,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3638.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9100.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9102.77,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2723.63,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4113.64,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9114.77,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11809.31,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7152.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":5966.62,"maximum":5966.62,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5966.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":10268.91,"maximum":11070.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10268.91,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11070.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":4548.59,"maximum":7965.23,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4548.59,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7965.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6042.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":4099.22,"maximum":4099.22,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4099.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":10805.62,"maximum":10805.62,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10805.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":6803.33,"maximum":6803.33,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6803.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":3972.51,"maximum":7752.10,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3972.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7752.10,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5481.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":4657.56,"maximum":5822.29,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5472.21,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4675.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4657.56,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5822.29,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5372.16,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5488.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":1358.15,"maximum":7361.12,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3915.35,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7361.12,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6532.36,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3389.56,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4494.35,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1358.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2612.6,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4352.20,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2316.92,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":1608.0,"maximum":6629.53,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6270.84,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6629.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":3699.84,"maximum":5329.07,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3699.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5329.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":6935.94,"maximum":17385.76,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17385.76,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6935.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11527.09,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14235.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":6969.6,"maximum":8125.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8125.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6969.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":28984.84,"maximum":32745.23,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32745.23,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28984.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":17273.62,"maximum":36648.38,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36648.38,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17273.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":19182.15,"maximum":54808.99,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29594.53,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54808.99,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31223.56,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19182.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29296.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22496.2,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28797.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":8345.62,"maximum":29658.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12169.76,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29658.84,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28105.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16130.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16426.44,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8345.62,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":12485.6,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10285.95,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13763.93,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10285.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":8404.09,"maximum":23123.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13868.4,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23123.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10699.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11243.14,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":12698.48,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8404.09,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11369.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":22930.03,"maximum":22930.03,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22930.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":10369.13,"maximum":15017.62,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10369.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15017.62,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14633.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":8725.23,"maximum":10533.61,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8725.23,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10533.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"minimum":10870.4,"maximum":10870.4,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10870.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"minimum":10258.88,"maximum":11923.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11923.52,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10258.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"minimum":12065.95,"maximum":12065.95,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12065.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":9616.88,"maximum":12042.05,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12042.05,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9616.88,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10277.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":7111.70,"maximum":7111.70,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7111.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":6996.08,"maximum":6996.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6996.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":7908.75,"maximum":12943.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12943.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7908.75,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7914.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":3689.82,"maximum":4900.96,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3689.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4900.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":12991.72,"maximum":15015.68,"setting":"inpatient","payers_information":[{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12991.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13550.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15015.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":7340.03,"maximum":13375.59,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13375.59,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9396.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7340.03,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9354.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":7479.22,"maximum":12512.52,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7479.22,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10007.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10941.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12512.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":3244.02,"maximum":14306.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3244.02,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6445.12,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14306.43,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6479.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7080.67,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7082.12,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11215.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":6352.51,"maximum":6352.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6352.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":7681.14,"maximum":7681.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7681.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"minimum":4588.12,"maximum":9872.4,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9872.4,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4588.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":3385.14,"maximum":10716.69,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10716.69,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3385.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5399.18,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7244.00,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4589.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":5064.16,"maximum":12745.97,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":12745.97,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5064.16,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5317.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":10242.61,"maximum":11522.26,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11522.26,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10242.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":3437.28,"maximum":9940.15,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9940.15,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8482.55,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3437.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6291.75,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5820.32,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3818.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":4221.82,"maximum":7938.8,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7151.26,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7938.8,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4221.82,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5141.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":3654.78,"maximum":14389.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9726.67,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3654.78,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14389.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8264.22,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9047.58,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8817.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":4163.34,"maximum":14869.05,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7779.65,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8394.21,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":14869.05,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4163.34,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5864.89,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4465.24,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7225.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":9770.63,"maximum":12738.44,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9770.63,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11384.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12738.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":5671.5,"maximum":11800.93,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11800.93,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6370.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5671.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":6482.37,"maximum":9562.34,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9562.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6482.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":10856.13,"maximum":10856.13,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10856.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":3915.61,"maximum":12904.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12904.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10225.91,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3915.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":16624.44,"maximum":17548.93,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17548.93,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16624.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"minimum":25827.45,"maximum":25827.45,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25827.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":16064.31,"maximum":28877.13,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28877.13,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28396.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16064.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":9863.03,"maximum":29926.4,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18575.64,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":29926.4,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9863.03,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11472.8,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11067.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":6717.52,"maximum":23717.15,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23717.15,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6717.52,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":7271.65,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"minimum":62813.15,"maximum":62813.15,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62813.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":4002.63,"maximum":13049.2,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5786.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13049.2,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9374.74,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4002.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":5977.48,"maximum":9064.57,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5977.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9064.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":5609.37,"maximum":27675.92,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5609.37,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27675.92,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12349.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12305.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":6269.89,"maximum":6269.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6269.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":6200.84,"maximum":13132.31,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6200.84,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11270.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13132.31,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11699.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":4507.86,"maximum":11281.03,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11281.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4507.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":4390.33,"maximum":4630.93,"setting":"inpatient","payers_information":[{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4390.33,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4630.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":7729.03,"maximum":12765.01,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9218.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11197.01,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12765.01,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7729.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":5371.14,"maximum":7992.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7992.6,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5371.14,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5786.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":7857.24,"maximum":7857.24,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7857.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":5141.07,"maximum":13101.83,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5141.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13101.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":1972.76,"maximum":6176.28,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1972.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6176.28,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5141.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":5854.64,"maximum":5854.64,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5854.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"minimum":26746.84,"maximum":26746.84,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26746.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":7136.74,"maximum":7136.74,"setting":"inpatient","payers_information":[{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7136.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":41560.0,"maximum":41560.0,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41560.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":7417.44,"maximum":28439.38,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28439.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7417.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":14676.83,"maximum":39270.71,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39270.71,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14676.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22873.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":7329.23,"maximum":24611.62,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24611.62,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7329.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13142.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":18046.82,"maximum":19549.04,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18402.68,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18046.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19214.16,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19549.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":2080.0,"maximum":14428.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2080.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13666.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14428.79,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14050.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":9568.21,"maximum":11160.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9568.21,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11160.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":20052.54,"maximum":20052.54,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20052.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"minimum":15591.93,"maximum":15591.93,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15591.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":1683.28,"maximum":8064.76,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1683.28,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8064.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":15747.24,"maximum":17909.0,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15747.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17909.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":12471.86,"maximum":12471.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12471.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"minimum":2960.53,"maximum":22509.29,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2960.53,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22509.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":8166.62,"maximum":8166.62,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8166.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":12289.36,"maximum":12289.36,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12289.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":9724.73,"maximum":9724.73,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9724.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":6954.32,"maximum":6954.32,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6954.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"minimum":9135.27,"maximum":9135.27,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9135.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":14239.1,"maximum":14239.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14239.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":17156.64,"maximum":17156.64,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17156.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":8888.29,"maximum":14719.15,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14719.15,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9892.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14107.7,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14510.28,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8888.29,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12827.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"minimum":10010.19,"maximum":10010.19,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10010.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":7589.6,"maximum":7589.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7589.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":3992.31,"maximum":4200.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4200.51,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3992.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":11567.93,"maximum":11567.93,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11567.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":7145.14,"maximum":7145.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7145.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":5925.52,"maximum":5925.52,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5925.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"minimum":39408.82,"maximum":39408.82,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39408.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":10163.38,"maximum":10163.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10163.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"minimum":15083.5,"maximum":15083.5,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15083.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":6964.28,"maximum":8031.18,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8031.18,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6964.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":3367.10,"maximum":3404.76,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3367.10,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3404.76,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3404.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"minimum":11507.72,"maximum":23246.04,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23246.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11507.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":4439.63,"maximum":6371.87,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4439.63,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6371.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":10408.21,"maximum":24661.59,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24661.59,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10977.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10408.21,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10951.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":3200.03,"maximum":7675.54,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3226.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4676.92,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6551.27,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3200.03,"methodology":"percent of total billed charges"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6392.44,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7675.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":5703.26,"maximum":5703.26,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5703.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":7967.03,"maximum":9745.31,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9745.31,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7967.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":9980.45,"maximum":9980.45,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9980.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":6960.08,"maximum":6960.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6960.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":11822.3,"maximum":11822.3,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11822.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":5891.51,"maximum":5891.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5891.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":5224.71,"maximum":12217.45,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12217.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10616.34,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5224.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"minimum":7546.0,"maximum":7546.0,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7546.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"minimum":12911.41,"maximum":12911.41,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12911.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":3932.93,"maximum":10763.60,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3932.93,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7848.55,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3932.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10265.20,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10763.60,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":1307.32,"maximum":10444.93,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5795.61,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3932.93,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10444.93,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7172.21,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3932.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4830.52,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6350.12,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1307.32,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3857.33,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1741.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":9481.85,"maximum":9481.85,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9481.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"minimum":3749.43,"maximum":3749.43,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3749.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":7762.33,"maximum":8175.85,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7762.33,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8175.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":9731.5,"maximum":9731.5,"setting":"inpatient","payers_information":[{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9731.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":8686.72,"maximum":8686.72,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8686.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":3571.01,"maximum":17286.2,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11683.84,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17286.2,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10216.47,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3571.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9416.79,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10216.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":1608.0,"maximum":9917.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6538.24,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5038.18,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9917.74,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7272.96,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6176.44,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5496.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6513.83,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3497.11,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2865.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":1608.0,"maximum":9446.49,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3497.11,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6215.65,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":9446.49,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3080.47,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":4061.80,"maximum":9326.72,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4061.80,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9313.53,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9326.72,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7919.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":1243.18,"maximum":6111.8,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6111.8,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5313.52,"methodology":"other"},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1243.18,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3075.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5115.3,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5719.31,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3636.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":9247.8,"maximum":9247.8,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9247.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":1599.36,"maximum":21333.6,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21333.6,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4809.28,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11576.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11534.83,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4662.44,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":7606.65,"maximum":13910.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13910.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7606.65,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7621.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":3915.38,"maximum":3915.38,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3915.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"minimum":40856.09,"maximum":40856.09,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40856.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"minimum":9685.55,"maximum":9685.55,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9685.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":16892.77,"maximum":17897.01,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16892.77,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17897.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":5860.8,"maximum":9521.79,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9039.9,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9521.79,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5860.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":7517.1,"maximum":12040.39,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10400.18,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12040.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8518.37,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7517.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"minimum":11296.34,"maximum":11296.34,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11296.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":20262.54,"maximum":20262.54,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20262.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":11687.58,"maximum":25352.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25352.14,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11687.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":16494.44,"maximum":16494.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16494.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":5623.1,"maximum":17695.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5623.1,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10563.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17695.24,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10604.82,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12713.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10563.22,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10149.16,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13804.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10582.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":3912.28,"maximum":8007.92,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6342.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8007.92,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":6032.33,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3912.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6327.35,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5446.61,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3912.28,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5733.46,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3912.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":3208.06,"maximum":6686.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6686.44,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4890.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3208.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"minimum":12306.59,"maximum":12306.59,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12306.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":7510.99,"maximum":7510.99,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7510.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"minimum":7379.42,"maximum":7379.42,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7379.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":8374.24,"maximum":9077.00,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9077.00,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8374.24,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8403.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":3119.44,"maximum":8145.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6266.2,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5891.0,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8145.42,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3119.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4623.01,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5898.67,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4215.16,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4464.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"minimum":11138.78,"maximum":11138.78,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11138.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":3875.87,"maximum":6106.55,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6106.55,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6005.69,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4398.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5726.91,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3875.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":3862.97,"maximum":3862.97,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3862.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":6315.66,"maximum":12673.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12673.97,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6315.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11597.45,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11597.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":5746.82,"maximum":7372.85,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7372.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5746.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7331.25,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7337.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"minimum":13349.44,"maximum":13349.44,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13349.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":13152.65,"maximum":13152.65,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13152.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":10246.88,"maximum":10246.88,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10246.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":4771.22,"maximum":7807.31,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7807.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4771.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"minimum":4971.51,"maximum":4971.51,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4971.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":13712.65,"maximum":16815.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16281.78,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16815.96,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13712.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"minimum":5468.41,"maximum":5468.41,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5468.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"minimum":8494.45,"maximum":8494.45,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8494.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"minimum":10501.29,"maximum":10501.29,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10501.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":1750.26,"maximum":4075.43,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3531.16,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1750.26,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2654.8,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4075.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":7716.38,"maximum":20763.6,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20763.6,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7716.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":2057.01,"maximum":2689.68,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2689.68,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2057.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":3510.6,"maximum":3510.6,"setting":"inpatient","payers_information":[{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3510.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":3465.42,"maximum":3510.6,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3510.6,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3465.42,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3510.6,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3510.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":2949.24,"maximum":10154.58,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2983.97,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10154.58,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8656.55,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2949.24,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2983.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":6079.44,"maximum":8876.04,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8876.04,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6079.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":3069.03,"maximum":17281.12,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5506.61,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11071.7,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11889.68,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4461.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17281.12,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3069.03,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5506.61,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5506.61,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5506.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":2598.46,"maximum":10896.12,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4442.0,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10896.12,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8792.31,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4461.3,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2598.46,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5638.44,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4442.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":1078.17,"maximum":1839.88,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1225.85,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1078.17,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1839.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":1107.39,"maximum":1664.29,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1107.39,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1402.46,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1303.16,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1664.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":1294.12,"maximum":1912.13,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1912.13,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1912.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1294.12,"maximum":1613.77,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1613.77,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1294.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1064.89,"maximum":1543.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1543.3,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1086.14,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1064.89,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1064.89,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1064.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"minimum":4075.43,"maximum":4075.43,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4075.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":3439.87,"maximum":8755.04,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8755.04,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3757.65,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3439.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":2834.76,"maximum":6561.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6561.32,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3217.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":1097.79,"maximum":8487.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5303.76,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3599.4,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6258.93,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6004.68,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":8487.21,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3916.56,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1097.79,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3852.49,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":2476.83,"maximum":7400.0,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2820.56,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2476.83,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6580.56,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5286.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2596.92,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2596.51,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2701.44,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.76,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7400.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6018.25,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2491.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":7650.81,"maximum":17049.31,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17049.31,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14735.55,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7650.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":8565.71,"maximum":8565.71,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8565.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":9908.76,"maximum":11343.8,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9908.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10740.04,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11343.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":4465.24,"maximum":6030.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5405.39,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4465.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6030.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":15279.7,"maximum":15279.7,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15279.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":5551.33,"maximum":7636.8,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5551.33,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7636.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"minimum":7795.48,"maximum":12682.7,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12682.7,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7795.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":6337.11,"maximum":6337.11,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6337.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":2640.12,"maximum":2640.12,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2640.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":3590.15,"maximum":3590.15,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3590.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":12717.38,"maximum":12717.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12717.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":12985.87,"maximum":12985.87,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12985.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":14181.7,"maximum":60441.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14181.7,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37941.12,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60441.0,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38005.63,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34154.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15335.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32512.87,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32984.44,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57014.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":2682.38,"maximum":28180.97,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28180.97,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14223.3,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2682.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12582.34,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13653.34,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8048.24,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3745.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":31901.05,"maximum":31901.05,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31901.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":12860.63,"maximum":20633.48,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20633.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12860.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":8858.76,"maximum":8858.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8858.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":5602.39,"maximum":5602.39,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5602.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"minimum":2177.79,"maximum":2177.79,"setting":"inpatient","payers_information":[{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2177.79,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":1950.0,"maximum":49019.15,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49019.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1950.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":4018.51,"maximum":23132.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14269.42,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6411.72,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4018.51,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12612.32,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22778.97,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23132.66,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13481.68,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11915.25,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6607.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13804.42,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13807.33,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6485.89,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12596.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":2359.59,"maximum":11513.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7434.14,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2359.59,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6340.95,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6743.29,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11350.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11513.55,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4555.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7391.02,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7394.05,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2860.15,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4006.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4555.07,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5893.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"minimum":1105.0,"maximum":5353.63,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2400.0,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1105.0,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":5353.63,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":1437.78,"maximum":9727.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4581.76,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6544.85,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3125.0,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5525.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9698.26,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":7563.73,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":5622.48,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9066.07,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9671.61,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1437.78,"methodology":"percent of total billed charges"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9682.27,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2400.0,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9727.59,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4500.0,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9075.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":2726.83,"maximum":2726.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2726.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":9255.0,"maximum":19553.9,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19553.9,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12472.36,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9255.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13261.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":1080.0,"maximum":7749.08,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3909.18,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4944.91,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1080.0,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7197.91,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2177.33,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7749.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6251.55,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6717.65,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":14509.06,"maximum":15068.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14509.06,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15068.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"minimum":12150.6,"maximum":12150.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12150.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":4418.79,"maximum":20511.49,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11827.63,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20511.49,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10610.99,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9604.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11496.05,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4418.79,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6549.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":3373.32,"maximum":6941.8,"setting":"inpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4774.58,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6941.8,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3373.32,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3418.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4685.33,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3473.42,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3440.38,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5193.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":6519.59,"maximum":11144.78,"setting":"inpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10052.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11144.78,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6519.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":5139.94,"maximum":15223.79,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15223.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5139.94,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7446.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"minimum":5668.59,"maximum":5668.59,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5668.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":8734.15,"maximum":18257.68,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18257.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8734.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":5229.34,"maximum":6206.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5229.34,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6206.76,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6076.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":18701.7,"maximum":28162.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18701.7,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28162.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":7065.89,"maximum":7065.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7065.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":21224.75,"maximum":21224.75,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21224.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":20388.74,"maximum":51308.69,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51308.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20388.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32376.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"minimum":13132.83,"maximum":13132.83,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13132.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":22952.2,"maximum":23194.18,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22952.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23194.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":8970.47,"maximum":8970.47,"setting":"inpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8970.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"minimum":7189.61,"maximum":7189.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7189.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"minimum":9603.5,"maximum":9603.5,"setting":"inpatient","payers_information":[{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":9603.5,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj efgart-alfa 2mg hya-qvfc","code_information":[{"code":"0723","type":"APC"}],"standard_charges":[{"minimum":16424.01,"maximum":17058.73,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16424.01,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17058.73,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16424.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj secukinumab intrav 1mg","code_information":[{"code":"0725","type":"APC"}],"standard_charges":[{"minimum":4580.88,"maximum":4580.88,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4580.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rasburicase","code_information":[{"code":"0738","type":"APC"}],"standard_charges":[{"minimum":5879.2,"maximum":17521.06,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17521.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5879.2,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7031.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, cyclophosphamide, nos","code_information":[{"code":"0743","type":"APC"}],"standard_charges":[{"minimum":784.75,"maximum":1343.07,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1343.07,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":784.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, donanemab-azbt, 2 mg","code_information":[{"code":"0765","type":"APC"}],"standard_charges":[{"minimum":976.33,"maximum":1660.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":976.33,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1654.48,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1660.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1597.64,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"minimum":995.83,"maximum":1209.24,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1209.24,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":995.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, romiplostim 1 microgram","code_information":[{"code":"0822","type":"APC"}],"standard_charges":[{"minimum":68.34,"maximum":7848.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2102.76,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7848.25,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Synvisc or synvisc-one","code_information":[{"code":"0874","type":"APC"}],"standard_charges":[{"minimum":387.41,"maximum":387.41,"setting":"outpatient","payers_information":[{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection,onabotulinumtoxinA","code_information":[{"code":"0902","type":"APC"}],"standard_charges":[{"minimum":569.34,"maximum":1810.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1255.81,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":753.05,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.34,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1359.67,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1810.27,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":735.86,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1388.73,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":845.66,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1361.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1621.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1513.84,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":902.46,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":851.78,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1335.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1557.88,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1166.79,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.86,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":856.38,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1573.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gammagard liquid injection","code_information":[{"code":"0944","type":"APC"}],"standard_charges":[{"minimum":1564.58,"maximum":9732.62,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1564.58,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2002.36,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3716.14,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2877.58,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4843.99,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9732.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3126.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gamunex-C/Gammaked","code_information":[{"code":"0948","type":"APC"}],"standard_charges":[{"minimum":4385.06,"maximum":4385.06,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4385.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Octreotide injection, depot","code_information":[{"code":"1207","type":"APC"}],"standard_charges":[{"minimum":6277.41,"maximum":17148.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6277.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":17148.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6630.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6800.88,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6396.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj iron dextran","code_information":[{"code":"1237","type":"APC"}],"standard_charges":[{"minimum":1314.26,"maximum":1314.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1314.26,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"AbobotulinumtoxinA","code_information":[{"code":"1289","type":"APC"}],"standard_charges":[{"minimum":726.56,"maximum":2799.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1583.24,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2378.44,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":726.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2799.22,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2438.18,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2475.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ferumoxytol, non-esrd","code_information":[{"code":"1297","type":"APC"}],"standard_charges":[{"minimum":211.3,"maximum":899.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":401.92,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.30,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.2,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":899.34,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":372.46,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.08,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":372.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Belimumab injection","code_information":[{"code":"1353","type":"APC"}],"standard_charges":[{"minimum":3071.09,"maximum":4716.12,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4716.12,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3071.09,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3152.74,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cyclophosphamide 100 MG inj","code_information":[{"code":"1408","type":"APC"}],"standard_charges":[{"minimum":1357.31,"maximum":1357.31,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1357.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Glassia injection","code_information":[{"code":"1415","type":"APC"}],"standard_charges":[{"minimum":3457.41,"maximum":3457.41,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3457.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj filgrastim excl biosimil","code_information":[{"code":"1469","type":"APC"}],"standard_charges":[{"minimum":492.68,"maximum":492.68,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":492.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Pertuzumab, 1 mg","code_information":[{"code":"1471","type":"APC"}],"standard_charges":[{"minimum":8436.22,"maximum":11467.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11467.34,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8436.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Certolizumab pegol inj 1mg","code_information":[{"code":"1474","type":"APC"}],"standard_charges":[{"minimum":397.82,"maximum":2264.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2264.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Golimumab for iv use 1mg","code_information":[{"code":"1475","type":"APC"}],"standard_charges":[{"minimum":1013.81,"maximum":4405.55,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1607.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1013.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1623.06,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4405.55,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Obinutuzumab inj","code_information":[{"code":"1476","type":"APC"}],"standard_charges":[{"minimum":7537.46,"maximum":7537.46,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7537.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Darbepoetin alfa, esrd use","code_information":[{"code":"1482","type":"APC"}],"standard_charges":[{"minimum":61.43,"maximum":1870.22,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1870.22,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.43,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj vedolizumab iv 1 mg","code_information":[{"code":"1489","type":"APC"}],"standard_charges":[{"minimum":3797.05,"maximum":7988.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6940.9,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7398.69,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7122.6,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3797.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7988.01,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6912.75,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3930.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj pembrolizumab","code_information":[{"code":"1490","type":"APC"}],"standard_charges":[{"minimum":6246.71,"maximum":26601.50,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6660.50,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11874.17,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12510.08,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26601.50,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11464.13,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12457.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13022.29,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11642.75,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":6246.71,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6729.75,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11110.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trastuzumab injection","code_information":[{"code":"1613","type":"APC"}],"standard_charges":[{"minimum":2812.71,"maximum":2812.71,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2812.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Darbepoetin alfa, non-esrd","code_information":[{"code":"1685","type":"APC"}],"standard_charges":[{"minimum":359.46,"maximum":1917.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.46,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":636.88,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1917.44,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":656.97,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":497.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":768.04,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.74,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":686.06,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epoetin alfa, non-esrd","code_information":[{"code":"1686","type":"APC"}],"standard_charges":[{"minimum":62.05,"maximum":387.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.39,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.31,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Paclitaxel protein bound","code_information":[{"code":"1712","type":"APC"}],"standard_charges":[{"minimum":3123.64,"maximum":9515.26,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9515.26,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3123.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4504.71,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3128.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, alemtuzumab","code_information":[{"code":"1809","type":"APC"}],"standard_charges":[{"minimum":15648.82,"maximum":15732.89,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15648.82,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15732.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, dalbavancin","code_information":[{"code":"1823","type":"APC"}],"standard_charges":[{"minimum":4808.25,"maximum":18300.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4808.25,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":18300.97,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4808.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"minimum":904.42,"maximum":6340.39,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2328.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":904.42,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1041.88,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6340.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inflectra","code_information":[{"code":"1847","type":"APC"}],"standard_charges":[{"minimum":312.86,"maximum":4047.67,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3300.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2299.33,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":419.98,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1361.34,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.02,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4047.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":312.86,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":578.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":38.31,"maximum":1033.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.74,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":123.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":192.51,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.89,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.89,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.24,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":181.3,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.21,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.33,"methodology":"other"},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.23,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":178.82,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":139.26,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.89,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":38.31,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.89,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.44,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.04,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"Phpmm","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.37,"methodology":"other"},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.5,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.27,"methodology":"other"},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.66,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.13,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.13,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.89,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":46.27,"maximum":226.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.0,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.27,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.27,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.21,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.24,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.46,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":226.59,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.0,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.42,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":175.32,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.27,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.73,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.55,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.27,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":77.95,"maximum":733.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.62,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":275.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":733.49,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.24,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.24,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.07,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.91,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.66,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.12,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.62,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.2,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.62,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":85.35,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.24,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.95,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143.2,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.42,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":469.43,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.24,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":148.7,"maximum":2990.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.8,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":958.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":950.25,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.6,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.36,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1108.96,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.14,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.56,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":1123.86,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":2990.88,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.52,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.8,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":223.53,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.95,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.6,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":734.86,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1100.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":860.01,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.7,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":230.83,"maximum":2500.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":487.02,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":2048.1,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1610.98,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.38,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.20,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.93,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1075.51,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.93,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2201.08,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1112.6,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.54,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":600.89,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1990.89,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.08,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":2325.30,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":2021.50,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":308.85,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":582.42,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.13,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":478.8,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.21,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.68,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.39,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":575.46,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":434.15,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2500.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.95,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.83,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":536.54,"maximum":22475.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":908.48,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":3189.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":4670.59,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":564.24,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.64,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1001.49,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1840.31,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1845.91,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":4727.27,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":613.45,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1007.16,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.43,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":889.14,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":6165.2,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":5647.04,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":536.54,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1089.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1036.5,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1008.5,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1322.32,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":566.99,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":580.76,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.96,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":955.30,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":22475.62,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":899.20,"methodology":"other"},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.98,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6125.45,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3024.28,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":562.58,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":885.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":715.21,"maximum":21088.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1641.32,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":785.92,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2127.97,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1646.07,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2995.38,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3289.15,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":8065.5,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1004.44,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.18,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":21088.31,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":1888.66,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":715.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1531.40,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1353.04,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1430.75,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":720.92,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":874.17,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1295.4,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8139.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1223.97,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1693.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"minimum":836.69,"maximum":5598.02,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5345.88,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5598.02,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":836.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3171.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1692.79,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2710.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":71.26,"maximum":191.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.29,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.36,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.26,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.29,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.29,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.18,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.57,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.58,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.34,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":188.97,"maximum":983.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.12,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.82,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.00,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.95,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":983.8,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.6,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":188.97,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.00,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.82,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.64,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.82,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":321.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":255.37,"maximum":627.89,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.21,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":553.15,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.37,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.74,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":627.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":547.65,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":380.17,"maximum":3759.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1732.85,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1761.9,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2561.31,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3759.58,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2392.28,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":380.17,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1594.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1601.78,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1590.19,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":963.03,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1622.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":331.03,"maximum":1743.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.02,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1696.43,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.69,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":619.02,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":914.92,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1169.45,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1743.7,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":385.02,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":620.52,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.69,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.44,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":619.02,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":377.78,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.69,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":701.45,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.88,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.03,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":668.24,"maximum":3772.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.53,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":3253.49,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":844.98,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":844.98,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.26,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1235.54,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1823.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3056.6,"methodology":"percent of total billed charges"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3772.42,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1420.76,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":1168.38,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":844.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.53,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1416.64,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":668.24,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":844.98,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":868.45,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.81,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1416.76,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3706.65,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3375.53,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1850.03,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":844.98,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1420.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":1468.94,"maximum":4936.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2484.83,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":4936.55,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1953.0,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.92,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2483.27,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4760.06,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3239.68,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1468.94,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2487.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2480.75,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1513.25,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.92,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.92,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1611.42,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4109.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":1986.59,"maximum":5691.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3323.83,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3329.33,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4888.68,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4825.13,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5686.37,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5691.47,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1986.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4015.72,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3330.61,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2052.49,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3816.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"minimum":257.4,"maximum":14169.29,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2998.44,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14169.29,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.4,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5805.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5757.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":82.12,"maximum":340.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.2,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.18,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.12,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.09,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.2,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.18,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.0,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.68,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.18,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.12,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":321.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"minimum":45.25,"maximum":456.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.88,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174.42,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.77,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.45,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":256.05,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.85,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.86,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.25,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":191.8,"maximum":327.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.9,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.8,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.18,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.39,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":327.45,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.21,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":320.9,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.8,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.8,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.74,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.8,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":327.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":82.18,"maximum":5277.98,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.64,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.28,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2076.17,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2650.87,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":5277.98,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.88,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":82.18,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1407.2,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1404.34,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1737.3,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.64,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.64,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1407.2,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.28,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3971.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":837.64,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1430.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":1686.96,"maximum":4472.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2828.81,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":4472.02,"methodology":"percent of total billed charges"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2825.26,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3551.94,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3976.20,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2834.03,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1686.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3128.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2822.51,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2433.12,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1686.96,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2825.51,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2478.0,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1686.96,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2859.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":2830.58,"maximum":29124.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6265.0,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":4156.16,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5102.4,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3728.53,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6243.82,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6251.19,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8256.61,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2830.58,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18766.5,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6245.32,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":20423.11,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3728.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7536.91,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6249.16,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":6473.96,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3728.53,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":29124.99,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3827.84,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3728.53,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6365.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":1427.82,"maximum":36787.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11577.05,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":12281.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":25220.15,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6897.42,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6960.19,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11576.25,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21409.46,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21445.78,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3752.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11576.21,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6911.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12857.27,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11570.75,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":8587.98,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6911.9,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.82,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11573.75,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":36787.76,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19530.44,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6229.43,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7400.66,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11617.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":9712.69,"maximum":38666.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14599.07,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32832.52,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30179.97,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16316.91,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9786.50,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16283.23,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16256.09,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":38666.33,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9712.69,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16250.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"minimum":167.18,"maximum":307.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.66,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.13,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.13,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.76,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.87,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":290.7,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":288.03,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.66,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.18,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.59,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":290.99,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.13,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Airway Endoscopy","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"minimum":212.81,"maximum":212.81,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":212.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":350.0,"maximum":6396.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1833.37,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":6396.16,"methodology":"percent of total billed charges"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1485.51,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1706.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3743.67,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.01,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":4654.29,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":884.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1725.33,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1909.70,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":903.22,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":892.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1020.05,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1510.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":666.43,"maximum":4132.81,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3265.49,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4132.81,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3409.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3278.82,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":666.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"minimum":3579.5,"maximum":6917.16,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6917.16,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3579.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":127.3,"maximum":396.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.57,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.59,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"minimum":292.48,"maximum":597.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":597.48,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.64,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.48,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":292.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":579.65,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":794.82,"maximum":2711.93,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.82,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2711.93,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1336.80,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1335.26,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.82,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1300.12,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.82,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1335.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"minimum":1579.28,"maximum":14744.4,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3332.19,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2686.60,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3312.92,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2818.95,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1677.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7571.88,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1579.28,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1677.99,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5708.99,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14744.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":2979.54,"maximum":5206.57,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.1,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5206.57,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.1,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5106.56,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.1,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2979.54,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":475.64,"maximum":661.82,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.64,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":554.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":661.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":547.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":834.68,"maximum":1639.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1396.54,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1639.99,"methodology":"percent of total billed charges"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1402.04,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1410.15,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1406.91,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.54,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":834.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1402.24,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1398.94,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":834.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":1661.24,"maximum":3624.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2781.98,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2784.98,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3624.4,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3268.77,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2788.65,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1661.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2779.48,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1969.08,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1662.27,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2779.48,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3375.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1662.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":381.92,"maximum":628.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.96,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":424.06,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":557.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":628.52,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.13,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":381.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":472.44,"maximum":6450.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.45,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":6450.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":5251.26,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.44,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.44,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":795.95,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1138.76,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1086.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":5207.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.9,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.72,"methodology":"other"},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.95,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.45,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":894.48,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":5069.77,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":4028.59,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":954.99,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":795.95,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1042.88,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":530.51,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.53,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":793.45,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.95,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3000.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1578.49,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472.44,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":806.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":991.71,"maximum":7410.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1665.14,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":6319.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":7410.2,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.71,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1664.76,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2290.71,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1991.45,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6499.09,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1041.3,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1666.26,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.71,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1825.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1666.03,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1659.93,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1470.3,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.71,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.71,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1662.26,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4882.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3012.67,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.71,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1693.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"minimum":1995.98,"maximum":12532.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3344.54,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":12532.57,"methodology":"percent of total billed charges"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3341.79,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5083.59,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4754.51,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5164.54,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1995.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3693.94,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3341.04,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5579.8,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3345.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":476.33,"maximum":4719.30,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":4593.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":4719.30,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":962.70,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.33,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":986.86,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1003.20,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":4414.59,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":748.18,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":3781.57,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":3888.26,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":939.31,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.33,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.33,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.97,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1682.26,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1913.36,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.33,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":813.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":615.02,"maximum":7367.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1029.02,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":7367.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":6445.22,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":733.13,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":851.24,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1029.02,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1154.91,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1159.13,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":5008.47,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5723.63,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":949.62,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1427.14,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7264.92,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5771.01,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1029.02,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":5708.22,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":5149.35,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":631.99,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1741.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1189.67,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1034.52,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1190.18,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":615.02,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":615.02,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2388.84,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1029.02,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":5573.39,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3008.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2291.42,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":842.91,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1050.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"minimum":1463.36,"maximum":7182.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2448.38,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2448.38,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3493.17,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2753.49,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":7182.49,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2448.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1463.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2458.38,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2451.88,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1762.5,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1463.36,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2448.38,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3047.30,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2498.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"minimum":4969.73,"maximum":6945.13,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4969.73,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6945.13,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4969.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4990.01,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4969.73,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5981.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":1803.1,"maximum":4873.97,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1803.1,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3022.32,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4521.3,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4168.96,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3023.27,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4873.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3644.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3016.82,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1976.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"minimum":6597.15,"maximum":6597.15,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6597.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":3007.18,"maximum":24110.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5037.06,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":14886.30,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3007.18,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4985.13,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.91,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7586.90,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7527.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":24110.41,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5038.41,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":21197.83,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3007.18,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5035.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6041.70,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.91,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4630.64,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3007.18,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3007.18,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5134.09,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6396.76,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9511.89,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8489.34,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3007.18,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5051.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"minimum":5364.84,"maximum":38979.22,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8981.58,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11023.60,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11098.57,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":38979.22,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27684.95,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9320.70,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5364.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10031.69,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8987.59,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":6262.12,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5364.84,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":37547.12,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13716.38,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5364.84,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9086.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"minimum":164.03,"maximum":285.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":285.63,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.71,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.42,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.51,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":164.03,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":356.02,"maximum":1445.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.67,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.02,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.28,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":942.39,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":602.67,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.02,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":599.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.1,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.30,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1445.89,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.02,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.02,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":630.98,"maximum":6817.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1782.24,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.54,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.54,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1781.59,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2702.54,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2494.60,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6817.4,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1114.62,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1783.09,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1783.34,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1776.82,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1636.6,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.54,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":630.98,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3008.77,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.54,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1783.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":1788.46,"maximum":10776.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3049.28,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3039.92,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3198.66,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4579.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":10776.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3046.37,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1816.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3672.72,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3039.92,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1955.31,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1788.46,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3046.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":1196.75,"maximum":11666.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4524.48,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":11666.56,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2696.75,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2696.75,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4517.52,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6065.82,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4637.21,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":10344.66,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.02,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4519.02,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":10026.26,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2696.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4901.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4513.86,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3248.56,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2660.28,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1196.75,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.02,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5740.29,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2696.75,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4604.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"minimum":4182.75,"maximum":21712.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8038.11,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4801.24,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8033.11,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11090.54,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":14311.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8040.11,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8037.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8065.75,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8033.21,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":4182.75,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21712.02,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4801.24,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8065.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"minimum":1349.69,"maximum":17661.53,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1349.69,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17596.92,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17661.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"minimum":169.15,"maximum":846.77,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":846.77,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":610.35,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":99.4,"maximum":3446.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":3446.93,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.85,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.30,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":247.2,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.46,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2149.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.31,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.08,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.03,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":118.35,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.85,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.4,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":650.93,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"minimum":167.2,"maximum":860.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":280.88,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.2,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.2,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":860.57,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.63,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.11,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.80,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.13,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.2,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.16,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"minimum":418.98,"maximum":991.00,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":841.37,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":418.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.00,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":704.22,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":418.98,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":718.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"minimum":1629.39,"maximum":4033.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2737.3,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3921.72,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3932.43,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2730.17,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2822.20,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2731.74,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2446.91,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4033.62,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1629.39,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2901.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"minimum":2589.34,"maximum":15216.10,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15216.10,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":9173.64,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2589.34,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4342.88,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4305.47,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":14357.5,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2592.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4354.94,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4339.98,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2694.34,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2592.29,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5511.09,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2592.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":1003.02,"maximum":8354.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.5,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":6032.28,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1006.28,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1683.63,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2369.49,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2286.49,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":8354.05,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4222.56,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1688.63,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.63,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1006.28,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1882.67,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1683.63,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1627.33,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1006.28,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1003.02,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2107.54,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6289.05,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4209.18,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4211.06,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":154.36,"maximum":1372.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.54,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":600.84,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.36,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.25,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":377.35,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.93,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":553.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1372.47,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":234.41,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.27,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.06,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.25,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.06,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.54,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":195.71,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.25,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.55,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.39,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":376.54,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.15,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":713.35,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.25,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":318.17,"maximum":6934.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":609.02,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1155.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1566.2,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.01,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":394.86,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.52,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.57,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":742.81,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1368.94,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.44,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6934.67,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":611.02,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":1114.34,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.42,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":605.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":728.55,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":604.25,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":318.17,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.42,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.98,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.02,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.94,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1090.40,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.42,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":646.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":475.04,"maximum":3290.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.08,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1477.12,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":628.25,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.04,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":800.31,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1515.39,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1515.39,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3136.92,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":498.79,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.09,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":3290.18,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":597.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.08,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1192.21,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":583.01,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.04,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":712.57,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":797.81,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3138.08,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1642.03,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":712.57,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"minimum":2969.4,"maximum":26856.38,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3307.58,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2969.4,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26856.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"minimum":2153.67,"maximum":6596.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5978.88,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6135.40,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4489.38,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5986.71,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3564.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6596.59,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5969.12,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2153.67,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3564.41,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6027.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"minimum":11401.03,"maximum":38339.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19153.27,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19075.42,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38339.76,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19125.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19108.06,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19076.44,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11401.03,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19272.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laser Eye Procedures","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"minimum":302.95,"maximum":629.14,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.95,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":622.14,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":629.14,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.40,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":624.67,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":622.14,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.84,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":624.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"minimum":1214.53,"maximum":9813.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2037.72,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.53,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2037.57,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3887.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":9813.3,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2040.07,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2040.36,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2036.19,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1880.41,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.53,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2035.07,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2056.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"minimum":2119.02,"maximum":3921.66,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3549.9,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3559.88,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2119.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3921.66,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3896.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"minimum":3548.4,"maximum":4576.13,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4563.03,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3551.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4326.84,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4559.39,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4560.53,"methodology":"other"},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3548.4,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4576.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"minimum":220.72,"maximum":1330.56,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.72,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.06,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":434.35,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5502","type":"APC"}],"standard_charges":[{"minimum":562.10,"maximum":1115.38,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":830.70,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1115.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1002.19,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":883.2,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":562.10,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.55,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":969.28,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"minimum":2038.52,"maximum":2079.27,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2043.18,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2043.48,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2045.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2046.0,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2038.52,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2079.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":34.51,"maximum":1305.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.57,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":304.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":351.4,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.64,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.32,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.83,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":368.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":523.75,"methodology":"other"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.14,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.73,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.24,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.22,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.86,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":323.92,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":281.88,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.40,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.86,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.38,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":78.24,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.51,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.94,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":573.02,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.38,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.68,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":57.3,"maximum":1173.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.25,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1147.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":967.21,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.26,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.72,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1009.87,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":540.58,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.17,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.56,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":599.41,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.82,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":936.06,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":534.71,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.06,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":240.87,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.68,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.56,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":746.50,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.66,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1173.68,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":618.97,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.3,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":127.71,"maximum":3180.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.03,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":2481.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":2528.53,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.67,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.95,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.95,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2444.38,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.1,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.67,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.03,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":2499.41,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":2347.8,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.10,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.11,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":516.51,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":234.94,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.67,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3180.38,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.25,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1571.19,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1017.0,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.71,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":287.52,"maximum":2017.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.03,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1183.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1843.67,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.06,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.06,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.06,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1736.35,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.9,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":697.73,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.16,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":1785.27,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":1635.26,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":529.28,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":482.04,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":366.9,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.26,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.06,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2017.95,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.52,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":95.76,"maximum":3637.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.73,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1058.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":3637.7,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.76,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.76,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.85,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.1,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":431.21,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2258.82,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1258.55,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1906.05,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.22,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.22,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.49,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":433.98,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":3494.3,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.76,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":279.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.58,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.86,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":478.88,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.63,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.16,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.17,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.22,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391.34,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":888.86,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":721.31,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.76,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":200.43,"maximum":6901.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.6,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":3261.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":3797.49,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.43,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.43,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.35,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":549.9,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":561.83,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3812.74,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2895.56,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.45,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.35,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3686.37,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.35,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.35,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":6901.5,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":3046.18,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.43,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":405.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":336.03,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":781.13,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.43,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203.00,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":644.53,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.35,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6556.16,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6463.84,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1017.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1017.0,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.43,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":417.3,"maximum":3699.87,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.06,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1145.78,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1275.25,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":3699.87,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":701.04,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":420.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":843.53,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":867.36,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":917.33,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":417.3,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1053.97,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.04,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":417.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":214.95,"maximum":2478.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.96,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1535.24,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.95,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.45,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":689.1,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.37,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1451.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.96,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":2478.02,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.96,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":362.65,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":306.72,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.95,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":376.99,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.45,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.05,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1508.32,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.95,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":281.7,"maximum":2921.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.98,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.44,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.7,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.96,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":857.3,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":857.3,"methodology":"other"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1803.71,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.13,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":2136.79,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.79,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.12,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":439.53,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.7,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2921.35,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2153.38,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.7,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":740.05,"maximum":6926.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1723.96,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1027.57,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":883.27,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1258.2,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1935.36,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1459.53,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6926.02,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1263.92,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":740.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1495.94,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1264.02,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1549.76,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":740.05,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1027.57,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1259.8,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4383.63,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":993.63,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1491.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"minimum":815.36,"maximum":6003.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.2,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1366.2,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2232.89,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2232.89,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":6003.98,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1370.2,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.77,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1364.2,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1268.67,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.36,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1365.2,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2018.46,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":47.45,"maximum":280.10,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.45,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":280.10,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.21,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.3,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":148.94,"maximum":904.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.55,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":904.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":74.54,"maximum":2260.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":314.72,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":428.79,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.11,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":2260.11,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":708.5,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.44,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":314.14,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":432.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":501.5,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":179.79,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":482.37,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"minimum":9.9,"maximum":1566.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.88,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.76,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9.9,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.75,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1566.3,"methodology":"other"},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.42,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.9,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.75,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.76,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.75,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":805.81,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.76,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9.9,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.75,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.9,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.76,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":19.44,"maximum":276.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.68,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":120.19,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.43,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.95,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":276.28,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.38,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.69,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.43,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.68,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":222.47,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.68,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.45,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.43,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.68,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.44,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.71,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":111.71,"maximum":1309.20,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.98,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":342.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1309.20,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":279.63,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.38,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.76,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.47,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.88,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":792.06,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.48,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.19,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.67,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":424.79,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":351.89,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.92,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.66,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":140.61,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.71,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.99,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.53,"methodology":"other"},{"payer_name":"Phpmm","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":424.79,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":604.17,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.47,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":276.0,"maximum":1511.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.59,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":541.04,"methodology":"percent of total billed charges"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":410.58,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1511.24,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.09,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.69,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":372.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":540.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.59,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.0,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.88,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.08,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":605.58,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1237.43,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":568.76,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":786.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":81.28,"maximum":626.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.77,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":537.54,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.41,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.41,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.21,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.62,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":469.8,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":539.22,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.48,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.21,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.21,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":554.41,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":459.27,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.27,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":113.94,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.41,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.28,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.41,"methodology":"other"},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.46,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.67,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.67,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.41,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":156.27,"maximum":1175.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.82,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1104.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":1175.55,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.59,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.59,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.7,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":605.87,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":518.85,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1150.86,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":742.96,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.77,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.82,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":864.46,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":942.98,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.59,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.7,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":177.66,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.59,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.27,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.9,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":977.13,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.59,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":284.4,"maximum":3786.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":584.14,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":2831.84,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.23,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.23,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":518.29,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1738.8,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2052.46,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":582.64,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":3786.16,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.02,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":541.56,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":358.86,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.23,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.4,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.93,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":384.79,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.23,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"minimum":544.91,"maximum":2127.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":980.87,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":976.88,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2127.86,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.91,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":957.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":6.21,"maximum":26.49,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.96,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.49,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6.21,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":18.95,"maximum":87.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.11,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.9,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.42,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.68,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.11,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.14,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.92,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.95,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.97,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":25.04,"maximum":709.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.43,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":416.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":587.37,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.88,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.88,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.89,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.04,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":467.66,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.83,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.47,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.46,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.56,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":627.98,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":342.0,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.43,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.45,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":66.75,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.88,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.98,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.56,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.43,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185.13,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.93,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.88,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":66.58,"maximum":1436.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.06,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":525.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":575.35,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.58,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1222.86,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.39,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":473.78,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.62,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1436.22,"methodology":"percent of total billed charges"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.39,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.09,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":640.54,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.58,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.84,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.43,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":212.73,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.58,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.58,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.59,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":112.04,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":299.31,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":404.91,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.58,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"minimum":207.66,"maximum":354.53,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.53,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.86,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.78,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"minimum":19.65,"maximum":648.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.01,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":592.45,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.65,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.65,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.04,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.96,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.96,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.94,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.55,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":573.68,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":475.24,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39.72,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.92,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":117.9,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.65,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.30,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":648.45,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.65,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"minimum":150.91,"maximum":150.91,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":115.63,"maximum":809.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.91,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":512.48,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471.0,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":510.25,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.63,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.22,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":636.66,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":251.46,"methodology":"percent of total billed charges"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":809.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":339.19,"maximum":5472.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.02,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":5472.53,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.19,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":567.52,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2043.43,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.80,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.62,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.71,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":627.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infliximab not biosimil 10mg","code_information":[{"code":"7043","type":"APC"}],"standard_charges":[{"minimum":778.04,"maximum":3014.79,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3014.79,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":778.04,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1309.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Doxorubicin inj 10mg","code_information":[{"code":"7046","type":"APC"}],"standard_charges":[{"minimum":864.46,"maximum":864.46,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":864.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alteplase recombinant","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"minimum":473.33,"maximum":775.64,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":775.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":662.86,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":473.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tenecteplase injection","code_information":[{"code":"9002","type":"APC"}],"standard_charges":[{"minimum":4755.69,"maximum":8590.29,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8590.29,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4755.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inclisiran, 1 mg","code_information":[{"code":"9004","type":"APC"}],"standard_charges":[{"minimum":3472.44,"maximum":3472.44,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3472.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj tezepelumab-ekko, 1mg","code_information":[{"code":"9008","type":"APC"}],"standard_charges":[{"minimum":2149.78,"maximum":4301.15,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2149.78,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3853.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4301.15,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3815.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj efgartigimod 2mg","code_information":[{"code":"9010","type":"APC"}],"standard_charges":[{"minimum":12960.97,"maximum":19286.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19286.31,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12995.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12960.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mmrv vaccine sc","code_information":[{"code":"9011","type":"APC"}],"standard_charges":[{"minimum":75.1,"maximum":75.1,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj risankizumab-rzaa?1 mg","code_information":[{"code":"9013","type":"APC"}],"standard_charges":[{"minimum":7503.24,"maximum":9031.31,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7503.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9031.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, renflexis","code_information":[{"code":"9036","type":"APC"}],"standard_charges":[{"minimum":1596.54,"maximum":1598.0,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1598.0,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1596.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Capsaicin 8% patch","code_information":[{"code":"9071","type":"APC"}],"standard_charges":[{"minimum":154.36,"maximum":4023.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4023.06,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.36,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3649.52,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3981.06,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2191.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2549.02,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3764.79,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2095.23,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3923.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, tremelimumab-actl, 1 mg","code_information":[{"code":"9110","type":"APC"}],"standard_charges":[{"minimum":52396.38,"maximum":52396.38,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52396.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Fulvestrant","code_information":[{"code":"9120","type":"APC"}],"standard_charges":[{"minimum":269.52,"maximum":642.02,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.02,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Natalizumab injection","code_information":[{"code":"9126","type":"APC"}],"standard_charges":[{"minimum":4043.98,"maximum":22739.78,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4087.03,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7289.87,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7707.25,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7707.25,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":21392.56,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4124.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22739.78,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4043.98,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11017.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prothrombin complex kcentra","code_information":[{"code":"9132","type":"APC"}],"standard_charges":[{"minimum":1952.62,"maximum":6233.30,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1952.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6233.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies ig, im/sc","code_information":[{"code":"9133","type":"APC"}],"standard_charges":[{"minimum":157.7,"maximum":9301.56,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9301.56,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.7,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4113.49,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":922.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies ig, heat treated","code_information":[{"code":"9134","type":"APC"}],"standard_charges":[{"minimum":771.77,"maximum":17797.8,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":771.77,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5771.97,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1095.06,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":17797.8,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8729.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6505.1,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5221.57,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3698.55,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7792.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":201.29,"maximum":1557.57,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1132.15,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1132.15,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":1452.1,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":474.99,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":394.14,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":306.84,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.29,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.66,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1557.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fecal?microbiota jslm 1 ml","code_information":[{"code":"9142","type":"APC"}],"standard_charges":[{"minimum":9413.84,"maximum":9413.84,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9413.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj ublituximab-xiiy, 1 mg","code_information":[{"code":"9149","type":"APC"}],"standard_charges":[{"minimum":11345.18,"maximum":68344.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30892.49,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":32439.07,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17225.36,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30654.24,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31511.09,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31589.33,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":67964.82,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30019.68,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":30407.39,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16763.00,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30688.76,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29999.92,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":14308.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11345.18,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68344.49,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30773.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, lecanemab-irmb, 1 mg","code_information":[{"code":"9157","type":"APC"}],"standard_charges":[{"minimum":315.68,"maximum":3014.78,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1110.27,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.68,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1166.76,"methodology":"other"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":3014.78,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1239.37,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1047.85,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1061.53,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.68,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1399.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, fulphila","code_information":[{"code":"9173","type":"APC"}],"standard_charges":[{"minimum":616.13,"maximum":1815.27,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1815.27,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":616.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1556.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, durolane 1 mg","code_information":[{"code":"9174","type":"APC"}],"standard_charges":[{"minimum":154.36,"maximum":1109.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.11,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":911.62,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.40,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":904.04,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":737.74,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":654.52,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.72,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1109.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., rituximab, 10 mg","code_information":[{"code":"9186","type":"APC"}],"standard_charges":[{"minimum":10048.89,"maximum":10048.89,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10048.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nivestym","code_information":[{"code":"9193","type":"APC"}],"standard_charges":[{"minimum":252.68,"maximum":252.68,"setting":"outpatient","payers_information":[{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":252.68,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"minimum":904.63,"maximum":2110.32,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2095.3,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1417.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1960.67,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":904.63,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2110.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, bortezomib, 0.1mg","code_information":[{"code":"9207","type":"APC"}],"standard_charges":[{"minimum":129.88,"maximum":468.34,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.88,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":468.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. pemetrexed nos 10mg","code_information":[{"code":"9213","type":"APC"}],"standard_charges":[{"minimum":722.67,"maximum":1376.44,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.44,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":722.67,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cetuximab injection","code_information":[{"code":"9215","type":"APC"}],"standard_charges":[{"minimum":4130.68,"maximum":4130.68,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4130.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"9217","type":"APC"}],"standard_charges":[{"minimum":374.68,"maximum":2385.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.6,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1135.72,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2193.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2385.77,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":641.43,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":374.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":655.62,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":648.3,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1239.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1356.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Abatacept injection","code_information":[{"code":"9230","type":"APC"}],"standard_charges":[{"minimum":1947.27,"maximum":4561.29,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4561.29,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1947.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Panitumumab injection","code_information":[{"code":"9235","type":"APC"}],"standard_charges":[{"minimum":5425.02,"maximum":24775.76,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24775.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5425.02,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6416.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Eculizumab injection","code_information":[{"code":"9236","type":"APC"}],"standard_charges":[{"minimum":26727.47,"maximum":26727.47,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26727.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, lanreotide acetate","code_information":[{"code":"9237","type":"APC"}],"standard_charges":[{"minimum":19636.74,"maximum":24712.45,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":24712.45,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19636.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Romiplostim injection","code_information":[{"code":"9245","type":"APC"}],"standard_charges":[{"minimum":263.13,"maximum":30542.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.13,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30542.37,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1289.33,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5012.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, amisulpride, 1 mg","code_information":[{"code":"9247","type":"APC"}],"standard_charges":[{"minimum":250.02,"maximum":250.02,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ustekinumab sub cu inj, 1 mg","code_information":[{"code":"9261","type":"APC"}],"standard_charges":[{"minimum":62.68,"maximum":14164.34,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14164.34,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13761.82,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3955.34,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj tofersen intrathec 1 mg","code_information":[{"code":"9262","type":"APC"}],"standard_charges":[{"minimum":15076.36,"maximum":15076.36,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15076.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tocilizumab injection","code_information":[{"code":"9264","type":"APC"}],"standard_charges":[{"minimum":1482.96,"maximum":3141.25,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1482.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1787.54,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3141.25,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2341.66,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj, denosumab","code_information":[{"code":"9272","type":"APC"}],"standard_charges":[{"minimum":1012.32,"maximum":5492.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1634.27,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":5492.79,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1276.92,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1652.71,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1897.42,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1588.04,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1550.37,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1012.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1855.85,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1555.88,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1097.44,"methodology":"percent of total billed charges"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1601.91,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2427.23,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1574.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cabazitaxel injection","code_information":[{"code":"9276","type":"APC"}],"standard_charges":[{"minimum":10844.35,"maximum":10844.35,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10844.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Altuviiio per factor viii iu","code_information":[{"code":"9277","type":"APC"}],"standard_charges":[{"minimum":72845.36,"maximum":72845.36,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72845.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Incobotulinumtoxin A","code_information":[{"code":"9278","type":"APC"}],"standard_charges":[{"minimum":2810.79,"maximum":2810.79,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2810.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ipilimumab injection","code_information":[{"code":"9284","type":"APC"}],"standard_charges":[{"minimum":104543.68,"maximum":104543.68,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":104543.68,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Brentuximab vedotin inj","code_information":[{"code":"9287","type":"APC"}],"standard_charges":[{"minimum":48919.96,"maximum":48919.96,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48919.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Omalizumab injection","code_information":[{"code":"9300","type":"APC"}],"standard_charges":[{"minimum":14.98,"maximum":1704.79,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15.26,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":1704.79,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., ravulizumab-cwvz 10 mg","code_information":[{"code":"9312","type":"APC"}],"standard_charges":[{"minimum":74538.9,"maximum":78422.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78422.35,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74538.9,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74975.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78148.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. herceptin hylecta, 10mg","code_information":[{"code":"9314","type":"APC"}],"standard_charges":[{"minimum":4688.50,"maximum":4688.50,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4688.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. romosozumab-aqqg 1 mg","code_information":[{"code":"9327","type":"APC"}],"standard_charges":[{"minimum":2269.05,"maximum":2741.38,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2650.42,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2271.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2741.38,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2269.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj mvasi 10 mg","code_information":[{"code":"9329","type":"APC"}],"standard_charges":[{"minimum":1255.22,"maximum":10432.57,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6535.22,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10432.57,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2393.94,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1577.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2505.55,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2373.55,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":3228.17,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1255.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., kanjinti, 10 mg","code_information":[{"code":"9330","type":"APC"}],"standard_charges":[{"minimum":1211.5,"maximum":2155.22,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2155.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1211.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, polatuzumab vedotin 1mg","code_information":[{"code":"9331","type":"APC"}],"standard_charges":[{"minimum":20560.7,"maximum":35722.46,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33412.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35722.46,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20560.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj luspatercept-aamt 0.25mg","code_information":[{"code":"9347","type":"APC"}],"standard_charges":[{"minimum":16133.47,"maximum":20642.24,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20642.24,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16133.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj fam-trastu deru-nxki 1mg","code_information":[{"code":"9353","type":"APC"}],"standard_charges":[{"minimum":6994.12,"maximum":24597.53,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11268.42,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24597.53,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6994.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. eptinezumab-jjmr 1 mg","code_information":[{"code":"9357","type":"APC"}],"standard_charges":[{"minimum":111.71,"maximum":5906.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1963.53,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":5134.86,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1099.24,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.71,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5533.38,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5817.25,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5835.71,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":5603.27,"methodology":"percent of total billed charges"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5518.69,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3075.19,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5593.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5593.24,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5496.26,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":2962.6,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1099.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5906.17,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5582.42,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3458.15,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3073.39,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5515.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj enfort vedo-ejfv 0.25mg","code_information":[{"code":"9364","type":"APC"}],"standard_charges":[{"minimum":18190.38,"maximum":19847.51,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18190.38,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19847.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj ruxience, 10 mg","code_information":[{"code":"9367","type":"APC"}],"standard_charges":[{"minimum":1560.10,"maximum":11019.94,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1560.10,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7339.61,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7304.49,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2616.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2653.83,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.6,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11019.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Sacituzumab govitecan-hziy","code_information":[{"code":"9376","type":"APC"}],"standard_charges":[{"minimum":1664.16,"maximum":37155.46,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37155.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10648.82,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1664.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Daratumumab, hyaluronidase","code_information":[{"code":"9378","type":"APC"}],"standard_charges":[{"minimum":8767.87,"maximum":28519.43,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8767.87,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28519.43,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10331.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9216.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9116.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. lurbinectedin, 0.1 mg","code_information":[{"code":"9389","type":"APC"}],"standard_charges":[{"minimum":8338.02,"maximum":8338.02,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8338.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pertuzu, trastuzu, 10 mg","code_information":[{"code":"9390","type":"APC"}],"standard_charges":[{"minimum":8214.85,"maximum":8214.85,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8214.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. inebilizumab-cdon, 1 mg","code_information":[{"code":"9394","type":"APC"}],"standard_charges":[{"minimum":312.44,"maximum":145234.29,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145234.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":312.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Covid-19 Vaccine Admin Dose 2 of 2, Single Dose Product or Additional Dose","code_information":[{"code":"9398","type":"APC"}],"standard_charges":[{"minimum":42.0,"maximum":140.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.35,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.06,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.61,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.25,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.24,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.13,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.13,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.0,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, nyvepria","code_information":[{"code":"9406","type":"APC"}],"standard_charges":[{"minimum":834.92,"maximum":5243.08,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":834.92,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5243.08,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4755.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1327.71,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":997.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Piflu f-18, dia 1 millicurie","code_information":[{"code":"9430","type":"APC"}],"standard_charges":[{"minimum":5425.32,"maximum":11534.55,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5425.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7451.27,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5961.66,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11534.55,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7196.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj anifrolumab-fnia 1mg","code_information":[{"code":"9434","type":"APC"}],"standard_charges":[{"minimum":2930.95,"maximum":2930.95,"setting":"outpatient","payers_information":[{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2930.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj pegfilgrast ex bio 0.5mg","code_information":[{"code":"9436","type":"APC"}],"standard_charges":[{"minimum":643.44,"maximum":643.44,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":643.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj ferric carboxymaltos 1mg","code_information":[{"code":"9441","type":"APC"}],"standard_charges":[{"minimum":473.74,"maximum":4369.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1064.52,"methodology":"other"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":563.4,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":582.27,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4369.16,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1034.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1244.36,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.08,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":924.97,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2988.81,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":473.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, nivolumab","code_information":[{"code":"9453","type":"APC"}],"standard_charges":[{"minimum":7636.62,"maximum":26255.36,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7636.62,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7638.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9330.3,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7722.71,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26255.36,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15224.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., benralizumab, 1 mg","code_information":[{"code":"9466","type":"APC"}],"standard_charges":[{"minimum":5.01,"maximum":5.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj rituximab, hyaluronidase","code_information":[{"code":"9467","type":"APC"}],"standard_charges":[{"minimum":5204.84,"maximum":5349.75,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5349.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5204.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, mepolizumab, 1mg","code_information":[{"code":"9473","type":"APC"}],"standard_charges":[{"minimum":3058.17,"maximum":3058.17,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3058.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, daratumumab 10 mg","code_information":[{"code":"9476","type":"APC"}],"standard_charges":[{"minimum":15358.42,"maximum":15358.42,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15358.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, reslizumab","code_information":[{"code":"9481","type":"APC"}],"standard_charges":[{"minimum":4181.41,"maximum":4181.41,"setting":"outpatient","payers_information":[{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4181.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, atezolizumab,10 mg","code_information":[{"code":"9483","type":"APC"}],"standard_charges":[{"minimum":10449.89,"maximum":12650.4,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10449.89,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12650.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ustekinumab, iv inject,1 mg","code_information":[{"code":"9487","type":"APC"}],"standard_charges":[{"minimum":2841.86,"maximum":17588.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5332.33,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":15639.68,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3701.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17588.0,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5108.88,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2841.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, nusinersen, 0.1mg","code_information":[{"code":"9489","type":"APC"}],"standard_charges":[{"minimum":143985.94,"maximum":471093.00,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":471093.00,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":143985.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, bezlotoxumab, 10 mg","code_information":[{"code":"9490","type":"APC"}],"standard_charges":[{"minimum":8835.45,"maximum":8835.45,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8835.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., durvalumab, 10 mg","code_information":[{"code":"9492","type":"APC"}],"standard_charges":[{"minimum":2383.82,"maximum":12930.00,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12835.31,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7863.46,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2383.82,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9530.17,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7273.52,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12930.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, ocrelizumab","code_information":[{"code":"9494","type":"APC"}],"standard_charges":[{"minimum":10153.26,"maximum":67100.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35570.43,"methodology":"other"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":48933.30,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10153.26,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35171.45,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37609.44,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37518.11,"methodology":"other"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67100.98,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35579.38,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19915.28,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35177.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35794.48,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35555.57,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":19224.95,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19860.21,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19900.39,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":39484.59,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45188.84,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45188.84,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20024.31,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35954.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"minimum":177.2,"maximum":2925.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2925.62,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.14,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"minimum":875.39,"maximum":875.39,"setting":"outpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":875.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"minimum":1037.56,"maximum":1513.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1037.56,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1039.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1335.47,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1513.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":10.28,"maximum":443.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.65,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":360.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":301.35,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.53,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.06,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.54,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.37,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":443.96,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.08,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.3,"methodology":"other"},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.04,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.52,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.17,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.07,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":16.93,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":14.03,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.48,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39.86,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17.51,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":90.39,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.16,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.13,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.57,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.18,"methodology":"other"},{"payer_name":"Phpmm","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.30,"methodology":"other"},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.86,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":282.39,"methodology":"percent of total billed charges"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.15,"methodology":"other"},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":316.82,"methodology":"other"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.09,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10.28,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.19,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":42.64,"maximum":2711.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":234.12,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":1218.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":839.68,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.22,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.72,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":225.78,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.32,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":475.0,"methodology":"percent of total billed charges"},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2570.34,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.64,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":256.01,"methodology":"other"},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":955.68,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.97,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":248.01,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":76.54,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.71,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.82,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.61,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":72.33,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.65,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.35,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.89,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.56,"methodology":"other"},{"payer_name":"Phpmm","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.94,"methodology":"other"},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2711.45,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":871.99,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.83,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":225.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"minimum":56.99,"maximum":581.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":38.00,"estimated_amount":502.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":59.20,"estimated_amount":502.75,"methodology":"percent of total billed charges"},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.99,"methodology":"other"},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.94,"methodology":"other"},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.03,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.03,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":473.49,"methodology":"percent of total billed charges"},{"payer_name":"Cofinity","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.28,"methodology":"other"},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.84,"methodology":"other"},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.96,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":57.83,"estimated_amount":486.83,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":47.91,"estimated_amount":403.28,"methodology":"percent of total billed charges"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.94,"methodology":"other"},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.11,"methodology":"other"},{"payer_name":"Medicare","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":12.00,"estimated_amount":100.05,"methodology":"percent of total billed charges"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.94,"methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.99,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.11,"methodology":"other"},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"},{"payer_name":"Priority Health","plan_name":"Commercial Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":56.80,"estimated_amount":473.49,"methodology":"percent of total billed charges"},{"payer_name":"Umr","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":500.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":550.28,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.94,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"minimum":253.68,"maximum":2238.36,"setting":"outpatient","payers_information":[{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1102.48,"methodology":"other"},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.68,"methodology":"other"},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1119.18,"methodology":"other"},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1119.18,"methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1119.18,"methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2238.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":4.08,"maximum":202.5,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.08,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"minimum":61.48,"maximum":61.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"minimum":567.14,"maximum":574.07,"setting":"outpatient","payers_information":[{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":567.14,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.07,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Medicaid level of care 6, as defined by each state","code":"U6","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Via interactive audio and video telecommunication systems","code":"GT","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Surgical Care Only","code":"54","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Postoperative Management Only","code":"55","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System","code":"95","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"93","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital","code":"PN","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate structure, a service that is distinct because it was performed on a separate organ/structure","code":"XS","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day","code":"GG","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Preferred","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Us Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bc Complete Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Mcr Advantage Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcn Of East Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield Mi","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Commericial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Medicare Hmo","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hap Preferred Ppo","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Commercial","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Health Advantage","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Healthplan Com","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mclaren Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Plus Blue Of Mi","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Memorial Healthcare Health Plan","plan_name":"Memorial Healthcare Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Php Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phpmm","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan Aca","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Health Plan","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"U Of M Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}]}